3P Exam Study APEA – Advanced Practice Education Associates – Comprehensive Review Notes for NP Certification Preparation

3P Exam Study APEA
Key Concepts in Healthcare

Pharmacology

Drug Interactions & Side Effects

 Digoxin Levels: ↓ Digoxin levels can be caused by Antacids.
 Pyridium (for UTI): May cause Hemolytic Anemia.
 Ototoxicity (Medications): Aminoglycosides, loop diuretics, NSAIDs,
antihistamines, nasal decongestants, Quinine, ASA.

Antihypertensives in Pregnancy

 Methyldopa (α-2-Agonist)
 Labetalol
 Nifedipine
 Hydralazine

ACE Inhibitors & ARBs - Important Considerations

 Common side effect of ACE Inhibitors: Dry, hacking cough (resolves
within a week of discontinuation).
 Indications: Patients with Diabetes Mellitus (DM), Chronic Kidney
Disease (CKD), and Hypertension (HTN).
 Cautions: Generally not recommended as first-line agents in African
Americans. Can cause angioedema.

Warfarin Management - Missed Dose

 Within 12 hours of scheduled time: Take the missed dose.
 Over 12 hours past scheduled time: Skip the dose and INR redraw will be
necessary.

Contraindications - Hydrochlorothiazide

 Sulfa allergy
 PCN hypersensitivity
 Asthma

,  Gout

Cardiology

Heart Murmurs

 Systolic Murmurs (Often Benign)
o Mitral Regurgitation (MR): May cause Shortness of Breath
(SOB), Fatigue, Heart Failure (HF).
o Physiologic Murmur (Peyton Manning): Typically Asymptomatic.
o Aortic Stenosis (AS): May cause Angina, Syncope, Heart Failure
(HF).
o Mitral Valve Prolapse (MVP): Often presents with a "Click", more
common in women aged 14-30, may cause Palpitations, Chest Pain.
 Diastolic Murmurs (Usually Abnormal)
o Aortic Regurgitation (AR): May cause Angina, Heart Failure
(HF), Dizziness, Chest Pain.
o Mitral Stenosis (MS): May cause Dyspnea, Atrial Fibrillation
(AFib).

Heart Sounds

 S1: Closure of the Atrioventricular Valves (Mitral & Tricuspid).
 S2: Closure of the Semilunar Valves (Aortic & Pulmonic).
 S3: Often heard in Congestive Heart Failure (CHF); may be normal in
athletic adolescents.
 S4: Often heard in Diastolic Heart Failure (HF), Left Ventricular
Hypertrophy (LVH), poorly controlled Hypertension (HTN), Myocardial
Infarction (MI).

Peripheral Artery Disease (PAD)

 Treatment: Antiplatelets (e.g., Clopidogrel/Plavix, Aspirin/ASA),
Pentoxifylline (decreases blood viscosity).
 Diagnosis:
o Gold Standard: Angiography.
o Ankle-Brachial Index (ABI).


Coronary Artery Disease (CAD) Treatment

,  Atorvastatin/Rosuvastatin: Use high doses if LDL > 150. Monitor Liver
Function Tests (LFTs) and arthralgia. Adjust type and dose if issues arise.
Helps stabilize plaques.

Heart Failure (HF) Medications

 ACE Inhibitors
 Angiotensin Receptor Blockers (ARBs)
 Angiotensin Receptor-Neprilysin Inhibitor (ARNI) with Beta-Blockers
(BBs)
 Aldosterone Receptor Antagonists

Infectious Diseases

Enterobiasis Vermicularis (Pinworm)

 Treatment Time: 2 weeks.
 Treatment: Pyrantel Pamoate - one dose initially, then another dose in 2
weeks. Re-test after 2 weeks of last dose.

Infective Endocarditis - Key Signs

 Janeway Lesions: Irregular, non-tender hemorrhagic macules on the hands
and feet.
 Osler's Nodes: Split pea-sized, erythematous, tender nodules on the pads of
the fingers and toes.

Giardiasis

 Signs & Symptoms: Foul-smelling stools, abdominal pain, flatulence
(can spread the disease), bloating/nausea/vomiting.
 Treatment: Metronidazole 250mg TID.

Hepatitis B & C

 Transmission: Bloodborne/Body fluids - highly infectious.
 Important Co-testing: Patients testing positive should also be tested for
HIV due to common transmission routes.

Tuberculosis (TB)