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Questions and Answers

What is a common side effect of ACE inhibitors?

Cough (correct)
Diarrhea

Why do ACE inhibitors cause a cough?

ACE inhibitors cause a cough due to the accumulation of bradykinin, a peptide normally broken down by the angiotensin-converting enzyme. Elevated bradykinin levels stimulate sensory nerves in the respiratory tract and promote mild airway inflammation, leading to a persistent dry cough in some patients. Switching to angiotensin receptor blockers (ARBs), which do not affect bradykinin, may alleviate this side effect.

What are some side effects of vasodilators?

Reflex tachycardia
Fluid retention
Headache, dizziness, weakness, fatigue (due to sudden decrease of BP)
All of the above (correct)

What is the mechanism of action of spironolactone?

Spironolactone blocks receptors of aldosterone. It retains potassium while excreting Na and water. It causes a smaller degree of diuresis, resulting in modest hypotensive effects. Signup and view all the answers

What is an x-waiver for prescribing medication? What law allows NPs to prescribe medication without an x-waiver?

X-waiver was a special authorization required for healthcare providers to prescribe buprenorphine to treat opioid use disorder (OUD). This waiver, mandated by the Drug Addiction Treatment Act of 2000 (DATA 2000), necessitated additional training and certification. Section 1262 of the Consolidated Appropriations Act of 2023 removed the federal requirement for practitioners to have x-waiver to prescribe medications. Signup and view all the answers

What is required to obtain a furnishing license in California for a nurse practitioner?

All of the above (E) Signup and view all the answers

What are the DEA requirements for controlled substances prescriptions?

All of the above (F) Signup and view all the answers

What are the 2 categories that expand nurse practitioner (NP) practice authority in California? (Select all that apply).

104 NP (A), 103 NP (B) Signup and view all the answers

What is CURES?

The California Prescription Drug Utilization Review and Evaluation System (CURES) is a program that helps to prevent prescription drug abuse. Healthcare providers are required to consult CURES before prescribing Schedule II–IV drugs for the first time and every 4 months for ongoing treatment. Signup and view all the answers

Which of these options are scheduled II controlled substances? (Select all that apply)

Opioids: Dilaudid, morphine, oxycodone, hydrocodone, fentanyl (A), Stimulants: Adderall, Ritalin, methamphetamine (B) Signup and view all the answers

What are some common side effects of opioid use? (Select all that apply)

CNS: sedation, drowsiness (A), GI: Nausea, constipation (B), Dermatological: pruritic, sweating (C), GU: urinary retention (D), Cardiovascular: hypotension (E), Respiratory: respiratory depression (F) Signup and view all the answers

What is the difference between HDL cholesterol and LDL cholesterol? (Select all that apply)

LDL cholesterol: only 50% is absorbed by liver, rest goes to peripheral cells (A), HDL cholesterol: produced in liver and intestine with function to remove LDL cholesterol from peripheral cells (B) Signup and view all the answers

When to start screening pediatric patients for hyperlipidemia? (Select all that apply)

At-risk children and adolescents: between 2 and 8 years (A), All children between ages 9 and 11 and another screening ages 18 and 21 years (B) Signup and view all the answers

What is the mechanism of action of statins?

Statins block the enzyme HMG-CoA reductase, reducing cholesterol production in the liver. (A), Decreases intracellular cholesterol levels, leading to increased uptake of LDL from the bloodstream. (B), Reduces triglycerides and slightly increases HDL levels. (C) Signup and view all the answers

What are the common side effects of statins? (Select all that apply)

Hepatotoxicity (A), GI disturbances (B), Headaches (C), Myalgia, possibly myopathy (D) Signup and view all the answers

What anti-cholesterol medication is contraindicated in pregnancy?

Statins (A) Signup and view all the answers

What is the mechanism of action of nitroglycerin? (Select all that apply)

Dilates peripheral arteries, veins, and coronary arteries. (A), Veins return less blood to heart, reducing preload which results in reduced cardiac workload. (B), Coronary arterial dilation increases blood flow and oxygen supply to myocardium. (C) Signup and view all the answers

What is BNP and why is it measured?

BNP (B-Type Naturiuretic Peptide) is a polypeptide secreted by the heart's ventricles in response to excessive stretching or wall tension, often due to worsening heart failure. It provides an objective measure of cardiac function and is a strong predictor of risk for death and cardiovascular events in heart failure patients. The normal range is <100 pg/mL. Signup and view all the answers

What is the first, second, and third line of treatment for an individual with heart failure? (Select all that apply)

ARB, beta blocker, aldosterone agonist, diuretic, and digoxin (A), ACE-I or ARB or ARNI with or without a diuretic (depends on fluid retention) (B), ACE-I or ARB or ARNI and beta blocker with a diuretic (C) Signup and view all the answers

Which beta blockers are used for heart failure? (Select all that apply)

Carvedilol (coreg) (A), Metoprolol succinate (Toprol XL) (B), Bisoprolol (Zebeta) (C) Signup and view all the answers

How to manage excessive Warfarin anticoagulation (INR)? Select the answers that best describe each level of INR

INR > 10 (A), INR 4.5 – 10 (B), INR < 4.5 (C) Signup and view all the answers

For newer anticoagulants, Pradaxa, Xarelto, Eliquis: What baseline labs are needed? (Select all that apply)

Renal Function: Creatinine, eGFR (dose adjustments needed for renal impairment). Hepatic Function: ALT, AST, bilirubin (important for rivaroxaban and apixaban). CBC: Monitor for anemia or thrombocytopenia. Signup and view all the answers

Which lab test is used to monitor therapeutic levels of heparin?

aPTT (A) Signup and view all the answers

Which anticoagulant is most appropriate as the first-line treatment for the following conditions?

Pulmonary Embolism (PE) / Deep Vein Thrombosis (DVT): Heparin (followed by oral anticoagulants like warfarin or DOACs for long-term management) (A), Transient Ischemic Attack (TIA): Aspirin (antiplatelet therapy is preferred for TIA) (B), Atrial Fibrillation (A-fib) (to prevent stroke): Warfarin or Apixaban (or other DOACs for A-fib stroke prevention) (C), Myocardial Infarction (MI): Aspirin and Clopidogrel (antiplatelet therapy is first-line for MI) (D) Signup and view all the answers

What are the classic signs of thalassemia?

Classic signs: fatigue, weakness, pallor, shortness of breath (A), Blood smear findings: microcytic, hypochromia, target cell and acanthocytes (cell with irregularly spaced bulbous projections) (B) Signup and view all the answers

What are the classic signs of B12 deficiency (pernicious) anemia?

Gastric mucosal atrophy, neurologic changes (paranoia, dementia, confusion, delirium), yellow-blue color blindness, fatigue, weakness. (A) Signup and view all the answers

What are the differences between positive and negative inotropic and chronotropic medications and their effects on cardiac contractility?

Inotropic Medications: Affect cardiac contractility (A), Chronotropic Medications: Affect heart rate (B) Signup and view all the answers

What is a hallmark side effect associated with amiodarone regarding skin that may concern patients?

Blue-gray skin discoloration (A) Signup and view all the answers

What happens at each phase in the phases of action potential in a myocardial cell? (Select all that apply)

Phase 0: Rapid depolarization from sodium influx (A), Phase 1: initial repolarization caused by transient potassium efflux. (B), Phase 4: Resting phase where the membrane potential is maintained by the sodium-potassium pump (C), Phase 2: Plateau phase where calcium influx balances potassium efflux, sustaining contraction. (D), Phase 3: Repolarization caused by potassium efflux (E) Signup and view all the answers

How do nitrates reduce cardiac workload and improve symptoms in patients with angina? (Select all that apply)

Nitrates are converted to nitric oxide, which causes vasodilation. This reduces preload (venous return to the heart) and afterload (arterial resistance), lowering cardiac workload and oxygen demand. This mechanism helps relieve angina symptoms. (A) Signup and view all the answers

What are the modifiable and non-modifiable risk factors for hyperlipidemia? (Select all that apply)

Modifiable Risk Factors: Include lifestyle factors such as poor diet, physical inactivity, obesity, and smoking, which can be changed to manage hyperlipidemia. (A), Non-modifiable Risk Factors: Include age, race, gender, and family history of hyperlipidemia or early cardiovascular disease, which cannot be altered (B) Signup and view all the answers

What are the adverse effects of Fibric Acid Derivatives? (Select all that apply)

GI disturbances, gallstones, myopathy (A) Signup and view all the answers

What risk factors are used when calculating a 10 year ASCVD risk assessment score? (Select all that apply)

The 10-year ASCVD Risk Score uses factors such as age, gender, race, total cholesterol, HDL cholesterol, blood pressure (treated or untreated), diabetes status, and smoking status to estimate the likelihood of a cardiovascular event in the next 10 years. (A) Signup and view all the answers

What is the mechanism of action of digoxin?

Digoxin inhibits the sodium-potassium ATPase pump. Indirectly leads to accumulation of intracellular calcium, causing increased myocardial contractility. (A) Signup and view all the answers

What is the mechanism of action of aspirin on the blood?

Aspirin inhibits platelet activation through irreversible enzyme antagonism to block prostaglandin synthesis. (A) Signup and view all the answers

What is the clinical presentation of aplastic anemia, and how is it treated?

Aplastic anemia treatments: Mild cases treated with supportive care. RBC transfusions and platelets given as necessary. (A), Aplastic anemia is caused by bone marrow failure, often due to autoimmune mechanisms, chemo/radiation, infections, or medications. It presents with fatigue, infections, bleeding, and pancytopenia (on CBC). (B) Signup and view all the answers

What are the different types of pain receptors and how do they work?

Thermal Nociceptors: (A), Chemical Nociceptors: (B), Mechanical Nociceptors: (C) Signup and view all the answers

Explain the schedules of controlled substances and their characteristics?

Schedule IV: Low abuse potential, accepted medical use (e.g., benzodiazepines) (A), Schedule I: No accepted medical use, high abuse potential (e.g., heroin, LSD) (B), Schedule III: Moderate abuse potential, accepted medical use (e.g., codeine combinations) (C), Schedule V: Lowest abuse potential, accepted medical use (e.g., cough preparations with codeine) (D), Schedule II: High abuse potential, restricted medical use (e.g., oxycodone, morphine) (E) Signup and view all the answers

How is pain transmitted in the body through the nociceptors? (Select all that apply)

When activated, nociceptors generate electrical signals (action potentials). These signals travel along sensory nerve fibers (Ad fibers for sharp, acute pain; C fibers for dull, throbbing pain) to the spinal cord and brain. The brain processes these signals, resulting in the perception of pain and initiating protective responses. (A) Signup and view all the answers

What are the signs and symptoms of opioid overdose and how is it managed? (Select all that apply)

Miosis (A), CNS depression (B), Altered mental status, stupor, or coma (C), Managed by correction of immediate life-threatening complications (airway assessment and intubation); Narcan. (D), Hypoventilation – severe respiratory depression (E) Signup and view all the answers

What is the mechanism of action of barbiturates?

This hyperpolarizes the neuron, making it less likely to fire and leading to CNS depression. (A), Barbiturates enhance the effect of GABA, the primary inhibitory neurotransmitter in the central nervous system (CNS) (B), They bind to the GABA-A receptor at a distinct site from GABA, increasing the duration that the chloride ion channel remains open. (C) Signup and view all the answers

What are the risk factors for hypertension? (Select all that apply)

Excessive sodium and low potassium intake (A), Family History (B), Race/Ethnicity (C), Smoking (D), DM and HLD (E), Alcohol (F), Physical inactivity (G), Obesity (BMI >30) (H), Age (I) Signup and view all the answers

Flashcards

ACE inhibitor side effect

A persistent, dry cough due to bradykinin buildup.

Vasodilator side effects

Reflex tachycardia, fluid retention, headache, dizziness, weakness, and fatigue due to rapid blood pressure drop.

Spironolactone MOA

Blocks aldosterone receptors, retaining potassium and excreting sodium and water, causing modest blood pressure decrease.

X-waiver for prescribing

Authorization to prescribe buprenorphine for opioid use disorder, previously required under DATA 2000.