TEST 2 questions.docx

1. **What Diuretic would you use in a patient with low GFR (renal impairment)?** Furosemide (loop diuretic) 2. **Low potassium can put a patient at risk for what when taking a diuretic?** Heart arrhythmia 3. **What patient education should you teach when prescribing Furosemide?** Mo...

1. **What Diuretic would you use in a patient with low GFR (renal impairment)?** Furosemide (loop diuretic) 2. **Low potassium can put a patient at risk for what when taking a diuretic?** Heart arrhythmia 3. **What patient education should you teach when prescribing Furosemide?** Monitor blood pressure, S/S of postural hypotension (stand slowly to avoid), eat K-rich foods (dried fruit, nuts, spinach, potatoes). 4. **What drugs should you avoid prescribing while a patient is taking Furosemide (Lasix)?** Digoxin (loss of K causes dysrhythmia), NSAIDS, Antihypertensive drugs, and Lithium. 5. **what is the difference between a loop diuretic and a thiazide diuretic?** A loop diuretic works by inhibiting sodium and chloride reabsorption in the loop of Henle in the kidneys, leading to a significant increase in urine production. Thiazide diuretics act on the distal convoluted tubule, also inhibiting sodium reabsorption but to a lesser extent, resulting in a moderate increase in urine output. 6. **If you had a patient who does not have adequate renal functioning and a GFR below 30, would you prescribe Hydrochlorothiazide (Microzide)? No**, you need adequate renal functioning for this diuretic. 7. **How long does it take for Diuresis to start in a patient taking Hydrochlorothiazide (Microzide)?** Starts in 2 hours and peaks 4-6 hours. 8. **What is important to check in your patient before prescribing Hydrochlorothiazide (Microzide)?** BP, HR, weight, S/S of hypokalemia (constipation, heart palpitation, fatigue, muscle weakness, and tingling), S/S of gout. 9. **What diuretic has a higher risk of ototoxicity?** Furosemide (loop Diuretic) 10. **Spironolactone (Aldactone): Aldosterone Antagonist is what type of diuretic?** Potassium sparing. 11. **What two useful responses does Spironolactone (Aldactone) produce?** They produce a modest increase in urine and a substantial decrease in potassium excretion. 12. **Would you use Spironolactone (Aldactone) alongside other diuretics?** Yes, because these drugs are used to counteract potassium loss caused by thiazide and loop diuretics. 13. **What is the main reason why Spironolactone (Aldactone) would be prescribed?** Alongside other diuretics to counteract the loss of potassium. 14. **What are some adverse effects of Spironolactone (Aldactone)?** Hyperkalemia (which like hypokalemia also causes dysrhythmia), gynecomastia, menstrual irregularities, impotence, hirsutism, deep voice. 15. **What is the BBW of Spironolactone (Aldactone)?** Shown to cause Tumor in rats, avoid unnecessary use. 16. **What baseline date would you need when prescribing Spironolactone (Aldactone)?** Weight, Vital signs, Electrolytes, and testosterone levels if prescribed in transgender patients. 17. **What types of interactions are possible in someone taking Spironolactone (Aldactone)?** Can help counteract the effects of potassium-wasting drugs (ACE, ARBs, direct renin inhibitors), caution when eating or taking potassium 18. **Would you instruct a patient to restrict or eat more potassium-rich foods while taking Spironolactone (Aldactone)?** Restrict! 19. **Triamterene (Dyrenium): Non-Aldosterone Antagonist is a?** Potassium-Sparing Diuretic 20. **What is the MOA of Triamterene (Dyrenium)?** Works to disrupt the sodium and potassium exchange that results in decrease sodium absorption and reduce potassium secretion. 21. **Should you prescribe someone Triamterene (Dyrenium) if they have elevated potassium?** No, this drug will cause an increase in K levels. 22. **How long does it take for Triamterene (Dyrenium) to start working?** A few hours 23. **What are some adverse effects of Triamterene (Dyrenium)?** Hyperkalemia, nausea vomiting, leg cramps, dizziness. 24. **What is the drug of choice when treating pregnant women with mild preeclampsia?** Labetalol and methyldopa 25. **What are the preferred antihypertensive drugs with Diabetics?** ACEI,s, ARBs, and diuretics in low doses. 26. **Why should Beta blockers be used with caution when prescribed to a Diabetic patient?** β blockers can suppress glycogenolysis and mask early signs of hypoglycemia 27. **Do African Americans suffer from high blood pressure, and increased risk of stroke and heart disease?** Yes 28. **What is the first choice of drugs use to treat hypertension in the African American population?** Diuretics 29. **In contrast with Caucasians, African American\'s monotherapy with these two drugs is less effective?** Betta blockers and ACEIs. (take away message, in some cases we may be able to use only one drug in a Caucasian but with African American we may need to use two drugs). 30. **What would be an example for African Americans to use ACEIs and Beta Blocker even though they are less effective?** For example, ACEIs should be used in African American patients who have type 1 diabetes with proteinuria. Also, ACEIs should be used in patients with hypertensive nephrosclerosis, a condition for which ACEIs are superior to CCBs 31. **When blood pressure cannot be adequately controlled by a single drug, what are the combinations that are recommended?** ACEI plus a thiazide diuretic, an ACEI plus a CCB, or a B blocker plus a thiazide 32. **What drugs are counteracted in pregnancy?** ACEIs, ARBS and DRI's. 33. **What two drugs would be recommended for a pregnant person to take?** Methyldopa and labetalol 34. **What four classes of drugs act on the Renin-Angiotensin-Aldosterone system?** Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), direct renin inhibitors (DRIs), and aldosterone antagonists 35. **What type of Drug is Lisinopril (Zestril)?** Angiotensin-converting enzyme Inhibitor (ACE) 36. **How does Lisinopril (Zestril): Angiotensin-Converting Enzyme Inhibitor work?** Lowers angiotensin II levels, Ace inhibitors dilate blood vessels and reduce blood volume, both lower blood pressure. Reduces cardiac afterload, increases cardiac output, and venous dilation, and suppresses aldosterone. Reduces glomerular filtration pressure via reducing levels of Angiotensin II. 37. **What are the uses for Lisinopril (Zestril): Angiotensin-Converting Enzyme Inhibitor?** HTN,CHF, acute MI, left ventricle dysfunction, Nephropathy, prevention of MI, stroke 38. **What are the contraindications of Lisinopril (Zestril):** Angiotensin-Converting Enzyme Inhibitor? Pregnancy and renal artery stenosis (can cause renal failure) 39. **What Baseline Data do you need before starting a patient on Lisinopril (Zestril): Angiotensin-Converting Enzyme Inhibitor?** Blood Pressure and Renal Function. 40. **Should Lisinopril (Zestril): Angiotensin-Converting Enzyme Inhibitor be given with Food?** Yes, usually given with food 41. **What are the Adverse Effects of** **Lisinopril (Zestril): Angiotensin-Converting Enzyme Inhibitor?** First-dose hypertension, hyperkalemia (due to inhibition of aldosterone and angiotensin) cough (bradykinin accumulation), renal failure, angioedema, neutropenia 42. **What is the big black warning for Lisinopril (Zestril): Angiotensin-Converting Enzyme Inhibitor?** Fetal injury, stop taking immediately. 43. **How can you prevent first dose hypotension while taking Lisinopril (Zestril): Angiotensin-Converting Enzyme Inhibitor?** Start with a low dose. 44. **What are some patient education that is important when prescribing Lisinopril (Zestril): Angiotensin-Converting Enzyme Inhibitor**? Educate about first dose hypotension, avoid K supplements, and notify the provider if develop cough or facial swelling. 45. **What should you monitor before starting a patient on Lisinopril (Zestril):** **Angiotensin-Converting Enzyme Inhibitor?** BP, proteinuria and GFR rate 46. **What are some of the factors that increase the chances of a cough while taking Lisinopril (Zestril): Angiotensin-Converting Enzyme Inhibitor and how long does it last after the medication is stopped?** Advanced age, female sex, and Asian ancestry. Should decrease after 3 days and be gone within 10. 47. **What are some interactions in regards to Lisinopril (Zestril): Angiotensin-Converting Enzyme Inhibitor?** Diuretics can make first-dose hypotension worse, drugs that increase K, lithium toxicity, and NSAIDS can reduce the effects of ACE-I 48. **What Class of drug is Losartan (Cozar)?** Angiotensin II receptoer Blocker (ARB) 49. **What is Losartan (Cozar) ARB approved for?** Hypertension, MI, diabetic nephropathy and prevention of stroke and death for people at high risk for cardiovascular evens. 50. **How does Losartan (ARB) differ from ACE inhibitors such as Lisinopril?** ACE inhibitors block production of angiotensin II, whereas ARBs block the actions of angiotensin II. Because both groups interfere with angiotensin II, they both have similar effects 51. **What is the primary difference in Losartan (ARB) than Lisinopril (ACE)?** ARB pose a much lower risk for cough or hyperkalemia. 52. **Would you use both a ACE and ARB at the same time?** No, they both have similar MOA and not appropriate to use at same time. 53. **ARB or ACE, which one is preferred for use and why?** ACE Inhibitors such as Lisinopril are preferred because they have been shown to decrease cardiovascular morbidity and mortality. 54. **What are the adverse effects and BBW of Losartan (Cozaar)?** Like ACE Inhibitors ARB such as Losartan has adverse effects of Angioedema, renal failure, and BBW of fetal harm, stop using if pregnancy is known. 55. **What is Aliskiren (Tekturna) Known as?** Direct Renin Inhibitor (DRIs) 56. **What is the MOA of Aliskiren (Tekturna) DRIs?** drugs that act on renin to inhibit the conversion of angiotensinogen into angiotensin I. By decreasing the production of angiotensin I, DRIs can suppress the entire RAAS. Currently, only one DRI available. 57. **What is the adverse effects of Aliskiren DRIs?** Just Like ACE inhibitors can develop cough, hyperkalemia but also Diarrhea in high doses (usually well tolerated at normal dosage). Also BBW if fetal injury and death like the others. 58. **What education is important with Aliskiren DRI's?** High-fat meals and grapefruit juice will decrease absorption and lower effect. 59. **What is Eplerenone (Inspra) known as?** Potassium-sparing aldosterone antagonist 60. **What is Eplerenone (inspra) MOA?** Selective blockade of aldosterone receptors without blocking receptors for other steroids hormones. Promotes retention of K and increased secretion of Na and water. reduces blood volume and BP 61. **What is the current recommendation guidelines when prescribing Eplerenone (Inspra)?** recommend adding an aldosterone antagonist to standard HF therapy, but only in patients with persistent symptoms despite adequate treatment with an ACEI and a β blocker 62. **What is contraindicated in prescribing Eplerenone (Inspra)?** Do no use with K supplements a K sparing Diretics, do not use with elevated K level or impaired renal function. 63. **Imprtont baseline to have before prescribing Eplerenone (inspra(?** BP, K level and GFR rate 64. **Important education regarding Eplerenone?** Teach S/S of hyperkalemia )confusion, dizziness, abnormal heart beat, SOB, numbness and tingling) 65. **Do Calcium Channel blockers have any significant effect on Veins?** No, At therapeutic doses, CCBs act selectively on peripheral arterioles and arteries and arterioles of the heart. CCBs have no significant effect on veins 66. **What is Diltizem (Cardizem) considered?** Calcium Channel Blocker (CCB) 67. **What are the uses for Diltizem (Cardizem)?** Angina, HTN, Dysrhythmia (Aflutter, A.Fib, PSVT) 68. **What is the baseline data needed before starting Diltizem (Cardizem)?** BP, HR, Liver function and kidney function 69. **What is the start and peak time of Diltizem (Cardizem)?** Works in minutes and peaks in 30min. 70. **What is contraindicaitons of Diltizem (Cardizem)?** Hypotension, sick sinus syndrome, 2^nd^ or 3^rd^ degree heart block. 71. **What are the adverse effects of Diltizem (Cardizem)?** Dizzyness, swelling of hands and feet, bradycardia, exema like rash in older adults 72. **What is Nifedipine (Procardia) considered?** Dihydropyridines Calcium Channel Blocker 73. **Can Nifedipine be used to treat Dsrhythmias?** No, nifedipine produces very little blockade of calcium channels in the heart 74. **What is Nifedipine MOA?** Blocks calcium channels in VSM vasodilationProduces very little blockage of calcium channels in the heart therefor does not ***Directly*** suppress automaticity, AV conduction, or contractile force. Net Effect: Lowers BP, increases HR, and contractile force 75. **What is the difference between Nifedipine IR and ER?** The reflex effect does not happen in ER release formula only the IR due to it being activated by fast drop in BP. ER or sustained release will only be used to treat hypertension. 76. **What are some of the contraindications with Nifedipine (CCB)?** IR dose is associated with increased mortality in MI and unstable Angina. 77. **Nifedipine is preferred to verapamil for patients with these disorders?** because nifedipine caAV block, heart failure, bradycardia, or sick sinus syndrome uses minimal blockade of calcium channels in the heart, the drug is not likely to exacerbate. 78. **What are the Adverse Effects if Nifedipine (Procardia)?** Flushing, dizzy, peripheral edema, gingival hyperplasia, chronic eczematous rash. IR exacerbation of angina, acute MI, hypotension, reflex tachycardia. 79. **What patient education and monitoring do you give when prescribing Nifedipine?** Monitor BP and Angina recored and teach patients to keep a angina record and monitor their blood pressure and AE. 80. **What is Hydralazine and MOA?** A Vasodilator. It works to dilate arterioles and peripheral resistance and arterial blood pressure fall, it does not affect the veins. 81. **What is the therapeutic goal of Hydralazine?** To reduce BP and reduce afterload a short time in CHF. 82. **If tachycardia refelex is severe what would you prescribe the patient to counteract this?** Betta Blocker 83. **What are interactions and adverse effect of Hydralazine?** Interactions can give with beta blocker to counteract AE. Caution with use in other hypotensive drugs. Adverse effects include postural hypotension, reflex tachy, myocardial contractility, NA and water retention and lupus like syndrome. 84. **In symptons of lupus like with hydralazine what are the signs and how long do they last?** Hydralazine can cause an acute rheumatoid syndrome that closely resembles systemic lupus erythematosus (SLE). Symptoms include muscle pain, joint pain, fever, nephritis, pericarditis, and the presence of antinuclear antibodies. Stop if this occurs. Symptoms are reversible, but it may take 6 months!!! 85. **What is the MOA of Digoxin (Lanoxin)?** Digoxin increases myocardial contractility, alters electrical activity of the heart. Reduces S/S of CHF but does not prolong life (second-line agent) 86. **What is the use of Digoxin?** To treat Dysrhythmia (A-fib or Flutter)or CHF 87. **What are some interactions of Digoxin?** Hy\[oklemia and increase risk of Dysrhythmia. Do not use in V-fib or Vtach 88. **What is important to monitor while prescribing digoxin?** Digoxin levels (has a low therapeutic window 0.5-0.8) apical pulse and assess for decreased S/S of CHF 89. What teaching should you give when prescribing Digoxin? Teach how to monitor HR, hold if below 50. Teach sings of toxicity (altered heart rate or rhythm, visual or gastrointestinal disturbances) 90. **What is the antidote for Digoxine?** Digibind 91. **What is metoprolol (Lopressor)?** Selective B-Adrenergic Bocker (B1) 92. **Metoprolol** is preferred for people with? Lung issues because it's a B1 it will only effect the heart not the lungs 93. **What does metoprolol treat ?**angina, HF, HTN and MI 94. **What is the first line blood pressure medicine for someone with diabetes and or kidney disease?** Ace 95. **What is the medication preference for African Americans?** Metoprolol 96. **What is the preferred medication when treating diabetic patients with high blood pressure?** ACE Lisinopril) or ARB (losartan) 97. **When first treating a patient with diabetes what is the first medication you should choose?** Metformin 98. **Patients who have type 2 diabetes who also have cardiovascular disease or cardiovascular risk, kidney disease or heart failure what type of medication should be prescribed?** Sodium-glucose cotransporter 2 inhibitor and or glucagon-like peptide 1 receptor agonist. 99. **For patients with a history of severe hypoglycemia and those with a limited life expectancy or advanced micro- and macrovascular complications, the target A~1C~ level should be ?** below 8.0. For most other patients with diabetes, the target is 7.0 and below. 100. **Youth who are overweight with new onset Diabetes has a AIC less that 8.**5 % what medication do you start them on? Metformin 101. **Youth who are overweight with AIC of greater than 8.**5% with no acidosis or without ketosis what medication do you start them on? Metformin and long-acting insulin 102. **Youth who are overweight and also have Acidosis what medication do you start them on?** Manage DKA or HHNK, IV insulin until acidosis resolves then subcutaneous, as for type I diabetes until antibodies are known. 103. **Why should Metformin and glyburide not be used as first-line treatment in pregnancy?** It crosses the placenta line 104. **Metformin when used to treat polycystic ovary syndrome and induce ovulation, when should it be discontinued?** By the end of the first trimester. 105. **What are the fasting glucose targets for pregnant women?** Less than 95 (5.3) and either I h postprandial glucose less than 140 (7.8 mm) 106. **Due to increased red blood cell turnover, A1C is slightly lower during pregnancy in people with and without diabetes. Ideally, the A1C target in pregnancy is ?** \