Exam 2 APN questions and answers
rated A+ updated
How often do you screen for smoking? - correct answer ✔✔ Every visit
Optimal LDL - correct answer ✔✔ <100
Guidelines for starting statin - correct answer ✔✔ - patients with any form of atherosclerotic
disease
- LDL >190
- patients with DM (aged 40 -75) with LDL of 70 - 189 mg/dL
- patients without DM (aged 40 -75) with an estimated 10-year ASCVD risk greater than or equal
to 7.5% (using calculator)
- statins decrease inflammation
Atorvastatin & simvastatin risks - correct answer ✔✔ - Myopathies, myalgia, rhabdo
- If they start getting myalgias bring down to lower dose
- Pravastatin & lovastatin are gentler statins
Statin therapy for patients with DM (aged 40 -75) with LDL of 70 - 189 mg/dL - correct answer
✔✔ - DM with no DM complications = moderate intensity statin
-DM with proteinuria, CKD, retinopathy, neuropathy = high intensity statin
Aspirin therapy is recommended for (USPSTF) - correct answer ✔✔ Adults with CAD aged 50 -
59 w/ 10% or RF for developing MI (based on Framingham risk scale)
,- As long as they are not at increased risk of bleeding, they have a life expectancy of at least 10
years, and they are willing to stay on aspirin for at least 10 years
Aspirin therapy is recommended for (American College of Cardiology) - correct answer ✔✔
Adults aged 40 - 70 years old as a primary prevention no matter what their risk scale is
- DO not recommend for patients greater than 70 or at increased risk of bleeding
Aspirin works... - correct answer ✔✔ Fast
- peak plasma levels in 20 min
- anti platelet effects in 60 min
Have pt's chew aspirin in office (325 mg) before sending them to ER if MI
Beta blockers in CAD - correct answer ✔✔ - Decrease myocardial O2 consumption
- Nonselective BB's help lower BP thus reducing myocardial contractility
- Reduce mortality / sudden cardiac death
-preferred beta blocker is carvedilol 6.25 up to 25 bid
Nitrates - correct answer ✔✔ - Includes nitroglycerin, isosorbide dinitrate, isosorbide
mononitrate
- Stable & unstable angina
- Promotes vascular smooth muscle relaxation --> arterial and venous dilation
- isosorbide dinitrate good for CHF pts
,Calcium Channel Blockers (-dipine) - correct answer ✔✔ - Treat angina and HTN
- Diltiazem, amlodipine, verapamil preferred b/c produce less reflex tachycardia
ACE inhibitors (-pril) - correct answer ✔✔ - renal protective
- cardio protective esp with low EF
- decrease cardiac mortality
- overall goal decrease BP
Angiotensin Receptor Blockers (-sartan) - correct answer ✔✔ - decrease cardiac mortality
- cardio protective esp with low EF
- overall goal decrease BP
icosapent ethyl (Vascepa) - correct answer ✔✔ - prescription fish oil
- triglycerides >135
- 26% risk reduction vs. fish oil no risk reduction but $$
Niacin - correct answer ✔✔ - no benefit to lowering LDL with statin however does lower
triglycerides if triglycerides >500 w/ statin
- skin flushing
ezetimibe (Zetia) - correct answer ✔✔ - adding 10 mg ezetimibe (Zetia) to simvastatin showed
risk reduction than simvastatin alone, reduce LDL
- if they can't tolerate high dose statin and they are high risk add zetia
Ranolazine (Ranexa) - correct answer ✔✔ Anti-anginal agent
, Stable angina - correct answer ✔✔ - Precipitated by exertion; relieved by rest or nitro (is a
decrease in myocardial O2 supply/ or increase demand)
- Levine sign = clenching fist over chest
- Usually brief. If lasting >20 minutes patient's should be seeking care
- Atypical symptoms seen frequently in women, elderly, diabetics (indigestion, fatigue)
Pharm management
- SL Nitro is med of choice (repeat in 3-5 min interval; call 911 after 2nd tab, if take 3rd tab chew
up 325 aspirin while waiting for amb)
- BB, CCB, long acting nitrates (isosorbide dinitrate or monitrate), ranexa, aspirin, ace/arb, statin
Unstable angina - correct answer ✔✔ Less predictable, intense, can occur at rest may or may
not be relieved by nitro
- physical exam findings --> pulmonary edema (course rales, crackles, rhonchi), new/worsening
mitral regurg murmur, s3 heart tone (CHF), hypotension, brady/tachycardia
pharm management
- anti-platetet (loading dose aspirin active MI)
- identified MI --> daily aspirin for first month (81 or 325) then 81 mg after first month
- nitrates (SL, topical, IV)
- preferred beta blocker is carvedilol 6.25 up to 25 bid
- CCB (not so effective in unstable angina, only help BP)
- statin
- aldosterone antagonist (spironolactone) for HF or ACS
Stable angina diagnostics - correct answer ✔✔ - EKG within 10 minutes
rated A+ updated
How often do you screen for smoking? - correct answer ✔✔ Every visit
Optimal LDL - correct answer ✔✔ <100
Guidelines for starting statin - correct answer ✔✔ - patients with any form of atherosclerotic
disease
- LDL >190
- patients with DM (aged 40 -75) with LDL of 70 - 189 mg/dL
- patients without DM (aged 40 -75) with an estimated 10-year ASCVD risk greater than or equal
to 7.5% (using calculator)
- statins decrease inflammation
Atorvastatin & simvastatin risks - correct answer ✔✔ - Myopathies, myalgia, rhabdo
- If they start getting myalgias bring down to lower dose
- Pravastatin & lovastatin are gentler statins
Statin therapy for patients with DM (aged 40 -75) with LDL of 70 - 189 mg/dL - correct answer
✔✔ - DM with no DM complications = moderate intensity statin
-DM with proteinuria, CKD, retinopathy, neuropathy = high intensity statin
Aspirin therapy is recommended for (USPSTF) - correct answer ✔✔ Adults with CAD aged 50 -
59 w/ 10% or RF for developing MI (based on Framingham risk scale)
,- As long as they are not at increased risk of bleeding, they have a life expectancy of at least 10
years, and they are willing to stay on aspirin for at least 10 years
Aspirin therapy is recommended for (American College of Cardiology) - correct answer ✔✔
Adults aged 40 - 70 years old as a primary prevention no matter what their risk scale is
- DO not recommend for patients greater than 70 or at increased risk of bleeding
Aspirin works... - correct answer ✔✔ Fast
- peak plasma levels in 20 min
- anti platelet effects in 60 min
Have pt's chew aspirin in office (325 mg) before sending them to ER if MI
Beta blockers in CAD - correct answer ✔✔ - Decrease myocardial O2 consumption
- Nonselective BB's help lower BP thus reducing myocardial contractility
- Reduce mortality / sudden cardiac death
-preferred beta blocker is carvedilol 6.25 up to 25 bid
Nitrates - correct answer ✔✔ - Includes nitroglycerin, isosorbide dinitrate, isosorbide
mononitrate
- Stable & unstable angina
- Promotes vascular smooth muscle relaxation --> arterial and venous dilation
- isosorbide dinitrate good for CHF pts
,Calcium Channel Blockers (-dipine) - correct answer ✔✔ - Treat angina and HTN
- Diltiazem, amlodipine, verapamil preferred b/c produce less reflex tachycardia
ACE inhibitors (-pril) - correct answer ✔✔ - renal protective
- cardio protective esp with low EF
- decrease cardiac mortality
- overall goal decrease BP
Angiotensin Receptor Blockers (-sartan) - correct answer ✔✔ - decrease cardiac mortality
- cardio protective esp with low EF
- overall goal decrease BP
icosapent ethyl (Vascepa) - correct answer ✔✔ - prescription fish oil
- triglycerides >135
- 26% risk reduction vs. fish oil no risk reduction but $$
Niacin - correct answer ✔✔ - no benefit to lowering LDL with statin however does lower
triglycerides if triglycerides >500 w/ statin
- skin flushing
ezetimibe (Zetia) - correct answer ✔✔ - adding 10 mg ezetimibe (Zetia) to simvastatin showed
risk reduction than simvastatin alone, reduce LDL
- if they can't tolerate high dose statin and they are high risk add zetia
Ranolazine (Ranexa) - correct answer ✔✔ Anti-anginal agent
, Stable angina - correct answer ✔✔ - Precipitated by exertion; relieved by rest or nitro (is a
decrease in myocardial O2 supply/ or increase demand)
- Levine sign = clenching fist over chest
- Usually brief. If lasting >20 minutes patient's should be seeking care
- Atypical symptoms seen frequently in women, elderly, diabetics (indigestion, fatigue)
Pharm management
- SL Nitro is med of choice (repeat in 3-5 min interval; call 911 after 2nd tab, if take 3rd tab chew
up 325 aspirin while waiting for amb)
- BB, CCB, long acting nitrates (isosorbide dinitrate or monitrate), ranexa, aspirin, ace/arb, statin
Unstable angina - correct answer ✔✔ Less predictable, intense, can occur at rest may or may
not be relieved by nitro
- physical exam findings --> pulmonary edema (course rales, crackles, rhonchi), new/worsening
mitral regurg murmur, s3 heart tone (CHF), hypotension, brady/tachycardia
pharm management
- anti-platetet (loading dose aspirin active MI)
- identified MI --> daily aspirin for first month (81 or 325) then 81 mg after first month
- nitrates (SL, topical, IV)
- preferred beta blocker is carvedilol 6.25 up to 25 bid
- CCB (not so effective in unstable angina, only help BP)
- statin
- aldosterone antagonist (spironolactone) for HF or ACS
Stable angina diagnostics - correct answer ✔✔ - EKG within 10 minutes
