PC 707 Cardiac Exam Questions With Verified Answers

Are the tow typeof CCBs mechanisms of action different? - Answer Dihydrophyridines: slow down the heart rate; Type 1 CCB: depress the muscles of the heart How do they differ in adverse effects? - Answer Dihydrophyridines (short acting) have a higher rate of adverse effects Are there certain indications of when to choose one CCB over the other? - Answer Long acting forms are suggested, however cost must considered to ensure compliance, extended release diltiazem is the most expensive, amlodipine is the only one that can be crushed for those with swallowing difficulties What are the differences between selective and nonselective beta-blockers? - Answer Nonselective can cause beta1 receptors to act on heart and lower the heart rate (good) and block beta2 receptors in the lungs and cause bronchoconstriction (bad); Selective will pick either Beta1 or Beta2: Beta1 receptors are concentrated in the heart (we only have one heart) and beta2 receptors are concentrated on the lungs (we have two lungs) Are there certain indications for each type of beta-blocker? - Answer What at is the recommendation #1 with JNC 8 and how is different from JNC 7? - Answer In the general population age 60 years or older, initiate pharmacologic treatment to lower b/p at SBP of 150 or higher and DBP off 90 or higher and treat to goal of SBP lower than 150 and DBP lower than 90; Higher cut-off in JNC 8 and raised goals in JNC 8 What at is the recommendation #2 with JNC 8 and how is different from JNC 7? - Answer In the general population younger than 60 years age, initiate pharmacologic treatment to lower BP at DBP 90 or higher and treat to goal of DBP lower than 90; the same What at is the recommendation #3 with JNC 8 and how is different from JNC 7? - Answer In the general population younger than 60 years age, initiate pharmacologic treatment to lower BP at SBP 140 or higher and treat to goal of SBP lower than140; the same What at is the recommendation #4 with JNC 8 and how is different from JNC 7? - Answer In the population aged 18 or older with CKD, initiated pharmacologic treatment to lower BP at SBP of 140 or higher or DBP of 90 or higher and treat to a goal of SBP of lower than 140 and DBP lower than 90; Lowered threshold in JNC 8 and raised goals in JNC 8 What at is the recommendation #5 with JNC 8 and how is different from JNC 7? - Answer In the population aged 18 or older with diabetes, initiated pharmacologic treatment to lower BP at SBP of 140 or higher or DBP of 90 or higher and treat to a goal of SBP of lower than 140 and DBP lower than 90; Lowered threshold in JNC 8 and raised goals in JNC 8 What at is the recommendation #6 with JNC 8 and how is different from JNC 7? - Answer In the general nonblack population, including those with diabetes initial antihypertensive treatment should include thiazide-type diuretic, CCB, ACEI, or ARB; Thiazides is no longer given preference as initial therapy, decreased to 4 main classes in, included diabetic treatment in with general population JNC 8 What at is the recommendation #7 with JNC 8 and how is different from JNC 7? - Answer In the general black population, including diabetes, initial antihypertensive treatment should include thiazide-type diuretics or CCB; Specific pharmacotherapy recommendation provided for African Americans, included diabetic patients in with general population in JNC 8 What at is the recommendation #8 with JNC 8 and how is different from JNC 7? - Answer In the population aged 18 years or older with CKD and hypertension, initial (or add on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patient with hypertension regardless of race or diabetes status. What at is the recommendation #9 with JNC 8 and how is different from JNC 7? - Answer The main objective of hypertension treatment is to attain and maintain goal BP. If goal BP is not reached within a month of treatment, increase the dose of the initial drug or add a second drug form one of the classes in recommendation 6. The clinician should continue to assess BP and adjust the treatment until goal BP is reached. If goal BP is not reached with 2 drugs, add and titrate a 3rd drug from the list provided. Do not use an ACEI and ARB together in the same patient. If goal BP is not reached using the drugs in recommendation 6 because of a contraindication or the need to use more than 3 drugs to reach goal BP, antihypertensive drugs from other classes can be used. Referral to a hypertension specialist may be indicated for patient in whom goal BP cannot be attained using the above strategy of the management of complicated patients for whom additional clinical consultation is needed.; Focus is on controlling BP using four classes in JNC 8 not on choice of agent for compelling indications as in JNC 7 What are the recommended steps when a patient has not reached the target goal? - Answer If the target goal is not reached within one month: 1. Increase dosage of the lst drug or add 2nd medication (thiazide, CCB, ACEI, ARB—do not combine ACEI and ARB); 2. Add a third drug if necessary (target goal sill not reached); a. If target goal BP cannot be achieved using drug classes in guidelines, chose drugs from a different class (e.g. BB, aldosterone antagonists); 3. Refer to a specialist; **MAX dose as appropriate of 1st drug, then 2nd drug, then 3rd drug then REFER Are there specific follow-up recommendations with HTN? - Answer monthly until b/p stable What are the laboratory values that must be monitored with the different antihypertensive classes (e.g., serum potassium must be checked when a patient is on an ACEI, etc)? - Answer ACEI: serum K+, serum Cr, WBCs; ARBs: Serum Cr, LFTs; Thiazides: electrolytes, BUN, Cr, uric acid, glucose; CCBs: LFTs What are the first-line and second-line drug classes for HTN? - Answer First-line: Thiazide type diuretics, CCB, ACEI, ARBs; Second-line: BB, aldosterone antagonists Are there specific classes for certain co-morbid conditions (e.g., for instance, if you have type 2 diabetes or kidney disease, are certain classes better than others)? - Answer Diabetes: ACEI (drug of choice); CKD: ACEI, ARBs; MI: BB; Osteoporosis: thiazides; Impaired kidney function > 75: CCBs and thiazides Are there any "natural" products that elevate blood pressure (BP)? - Answer Sympathomimetic agents such as pseudoephedrine and methylphenidate; NSAIDs; COX-2 inhibitors; Corticosteroids; CNS stimulants such as caffeine; Estrogens and progestin; SNRIs such as venlafaxine & sibutramine; Immunosuppressants such as cyclosporine and tacrolimus Are there any over-the-counter medications hypertensive patients should avoid (e.g., CCMs, NSAIDs)? - Answer NSAIDs; Sympathomimetic agents especially pseudoephedrine in OTC cough and cold medicines; devil's claw; ginseng; goldenseal; black licorice; ma huang; squill; yohimbe. How do you treat hyperlipidemia? - Answer With statins How has the management recently changed? - Answer Focuses on reducing the risk of ASCVD in four statin benefit groups. 1. Persons with clinical ASCVD; 2. Person with primary elevations of LDL-C levels of 190 mg/dL or greater; 3. Persons with DM who are 40-75 years of age with LDL=C levels of 70-189 mg/dL but without ASCVD; 4. Persons without ASCVD or diabetes with LDL-C levels of 70-189 mg/dL and an estimated 10 year ASCVD risk of 7.5% What are the adverse effects associated with each of the drug classes for treating hyperlipidemia? - Answer Statins: muscle aches or weakness How do the different drug classes impact the lipid profile (e.g., do plant sterols decrease LDL, does niacin raise HDL)? - Answer Statins: lower LDL; Niacin: increase HDL; Selective Intestinal Cholesterol Inhibitors: lower lipids; Bile acid: lower cholesterol; Fibric Acid derivatives: lower triglycerides and increase HDL What is myopathy? - Answer Muscle pain How can you reduce patient risk? - Answer Combination of statins and fibrates What patient education must be provided when managing a patient with statins? - Answer To the symptoms are new and unexplained hold the statin and if notify HCP immediately What are the signs and symptoms of rhabdomyolysis? - Answer Abdominal pain, Dark Urine, Severe Muscle pain