Therapeutics Exam 4

Angina Pectoris can be precipitated by all of the following except:

• A.

  Failing a therapeutics test because of a poorly graded question

• B.

  Getting in a fight with your parents

• C.

  Jogging

• D.

  Laying on the couch after a meal

• E.

  Walking to your car in a blizzard

Which are considered non-modifiable CHD risk factors:

• A.

  Type 2 Diabetes

• B.

  Being 70

• C.

  Premature menopause

• D.

  LDL of 120

• E.

  HDL of 39

• F.

  Your grandpa had a heart attack at 55

• G.

  Your mother had coronary ischemia at 59

If Jimmy believes he is having his 2nd acute coronary event, but doesn't feel like he is in too much pain, it is OK for his wife to drive him to the ER because he doesn't have insurance.

• A.

  True

• B.

  False

The COURAGE trial showed that patients who have stable ischemic heart disease who receive PCI have a decreased incidence mortality in 4 years than patients who are med treated

• A.

  True

• B.

  False

ACE-I should be considered for patients with Stable Ischemic Heart Disease with these other co-morbid diseases, EXCEPT

• A.

  Hyperlipidemia

• B.

  Diabetes

• C.

  HTN

• D.

  CKD

• E.

  LV systolic dysfunction

Beta blockers improve angina symptoms in patients with stable ischemic heart disease, but do not affect mortality.

• A.

  True

• B.

  False

If a patient has had a recent MI, their LDL goal is 

• A.

• B.

• C.

• D.

Which are counseling points when dispensing SL NTG?

• A.

  Keep with you at all times! May keep in a coat pocket, purse, fanny pack or shirt pocket.

• B.

  Discard if tablets become "fuzzy" or until expiration date on bottle

• C.

  Discard every 6 months

• D.

  Place on the tongue every 5 minutes for 3 doses for refractory angina (as long as doctor is aware they are taking 3 doses before calling 911)

• E.

  May cause an increase in heart rate

• F.

  May be used as an analgesic

• G.

  Take while sitting down

Short-acting Nifedipine can be used for ischemic heart disease.

• A.

  True

• B.

  False

Which CCB is the drug of choice for stable ischemic heart disease if the patient also has systolic heart failure?

• A.

  Nifedipine

• B.

  Cardizem

• C.

  Diltiazem

• D.

  Amlodipine

Which cardiac enzyme stays elevated for the longest period of time (on average)?

• A.

  Troponin

• B.

  Myoglobin

• C.

  CK-MB

• D.

  CK

In a patient who had a previous MI but was unaware of it, what will be different on their EKG?

• A.

  ST depression

• B.

  T wave inversion

• C.

  Q wave

• D.

  Nothing

When determining what type of acute coronary syndrome (ACS) a patient is experiencing, what are the 3 signs and symptoms that need to be evaluated? EKG, cardiac enzymes and:

Upon presenting to the ER for a NSTEMI, the patient should be given 81 mg ASA ASAP

• A.

  True

• B.

  False

The correct morphine dosing for UA/NSTEMI is:

• A.

  2-4 mg/kg IV with increments of 2-8 mg/kg IV repeated at 5-15 min intervals

• B.

  2-4 mg IV with increments of 2-8 mg IV repeated at 5-15 min intervals

• C.

  1-2 mg/kg IV with increments of 2-10 mg/kg IV repeated at 5-15 min intervals

• D.

  1-2 mg IV with increments of 4-8 mg IV repeated at 5-15 min intervals

The correct NTG IV dosing for a patient presenting with UA/NSTEMI is:

• A.

  2-4 mg/min IV up to 100 mg/min IV until relief or limiting symptoms

• B.

  5-10 mg/min IV up to 200 mg/min IV until relief or limiting symptoms

• C.

  1-2 mcg/min IV up to 200 mcg/min IV until relief or limiting symptoms

• D.

  5-10 mcg/min IV up to 200 mcg/min IV until relief or limiting symptoms

Clopidogrel has more rapid onset and more platelet inhibition than ticagrelor

• A.

  True

• B.

  False

If the patient is 76 years old and weights 130 pounds, she should be given the 5mg QD dose of Prasugrel

• A.

  True

• B.

  False

Fibrinolytic therapy should ALWAYS be initiated for a STEMI at a non-PCI-capable facility even if it has been 2 days since symptom onset

• A.

  True

• B.

  False

Triple therapy for refractory angina includes all of the following EXCEPT:

• A.

  Long-acting nitrates

• B.

  CCB

• C.

  ACE-I

• D.

  BB

Norepinephrine generally works by promoting sodium retention, increasing ventricular hypertrophy, increased cardiac fibrosisis and oxidative stress. 

• A.

  True

• B.

  False

2/3 of heart failure hospitalizations are due to MIs.

• A.

  True

• B.

  False

Which are negative inotropic medications?

• A.

  Doxorubicin

• B.

  Some BBs

• C.

  CCB

• D.

  Terbinafine

• E.

  Amphetamines

• F.

  COX2 inhibitors

• G.

  Antiarrhythmics

• H.

  Imatinib

Which does not have a mortality benefit in systolic heart failure?

• A.

  BB

• B.

  ACE-I

• C.

  Diuretics

• D.

  Aldosterone Antagonists

Which drug CAN be used for systolic HF but absolutely should not be used in diastolic HF?

• A.

  Digoxin

• B.

  Metoprolol Tartrate

• C.

  Metoprolol Succinate

The EF in diastolic is usually decreased or preserved but the LV wall thickness is always:

• A.

  Decreased or preserved

• B.

  Preserved

• C.

  Thickened

• D.

  Hypertrophied

If a patient presents with decreased BP, ascites, pale skin, confusion, edema and worsening renal function, we could classify them as

• A.

  I - warm and dry

• B.

  II - warm and wet

• C.

  III - cold and dry

• D.

  IV - cold and wet

A BNP level of 453 is considered: 

• A.

  Mild

• B.

  Moderate

• C.

  Severe

All are appropriate IV loop doses for a patient who is "diuretic-naive" except:

• A.

  40 mg furosemide

• B.

  2 mg bumetanide

• C.

  10 mg torsemide

• D.

  20 mg torsemide

If the fluid output after 40 mg furosemide IV is 125 mL after 2 hours, which of the following are options:

• A.

  80 mg furosemide IV

• B.

  80 mg furosemide IV + continuous IV infusion

• C.

  Nothing, this is sufficient urine output

• D.

  80 mg furosemide IV + oral metolazone

• E.

  80 mg furosemide IV + IV HCTZ

Which is the inotrope of choice if the patient has a BP of 90/60?

• A.

  Dopamine

• B.

  Dobutamine

• C.

  NTG

• D.

  Milrinone

Which is the inotrope of choice if the patient is on a beta blocker and is not hypotensive.

• A.

  Dobutamine

• B.

  Dopamine

• C.

  Milrinone

If a patient is on carvedilol, their response to dobutamine during decompensated HF will be increased.

• A.

  True

• B.

  False

If a patient has an ABI of .75, they are in the category of _____.

• A.

  Mild

• B.

  Borderline

• C.

  Moderate

• D.

  Severe

Patient has PAD and presents with the following symptoms...what is the treatment? Mild pain No motor deficit Inaudible artrial doppler Inaudible venous doppler Complete sensory deficit

• A.

  None

• B.

  Urgent work-up

• C.

  Emergency surgery

• D.

  Amputation

The recommended antithrombotic therapy for refractory IC is:

• A.

  Clopidogrel 75 mg/day

• B.

  ASA 81 mg/day

• C.

  Clopidogrel 75 mg/day + cilostazol 100 mg BID

• D.

  Cilostazol 100 mg BID

Cilostazol should be administered 2 hours before meals or 30 minutes after.

• A.

  True

• B.

  False

Which are risk factors for carotid atherosclerotic disease?

• A.

  Age >50

• B.

  Cigarette smoking

• C.

  DM

• D.

  HTN

• E.

  HLD (hyperlipidemia)

• F.

  Inactivity

Goals for treating PAD include:

• A.

  Increasing maximum walking distance

• B.

  Increasing duration of pain-free walking

• C.

  Preventing critical limb ischemia

• D.

  Improving co-morbid conditions

• E.

  Improving quality of life

Which is not a s/s of PAD?

• A.

  Cool skin

• B.

  Thick toenails

• C.

  Pallor

• D.

  Ulcers

• E.

  Absent peripheral pulse

• F.

  Lower-limb edema

• G.

  Lack of hair on lower extremities

Symptoms for Aortic Stenosis include:

• A.

  Hemoptysis

• B.

  Atypical CP

• C.

  Palpitations

• D.

  Orthopnea

• E.

  Fatigue

• F.

  Dyspnea on exertion DOE

If a patient undergoes mitral valve replacement and has a mechanical 1st generation valve placed, they must be placed on VKA therapy with a goal INR of _______ and a treatment duration of ________.

• A.

  2-3; life

• B.

  2.5-3.5; life

• C.

  2.5-3.5; 3 months

• D.

  2-3; 3 months

Patient B has mitral valve regurgitation and is undergoing a root canal. She is allergic to penicillin. Which prophylaxis antibiotic should she take?

Patient A is undergoing aortic valve replacement therapy due to her severe aortic regurgitation and is going to have a 2nd generation mechanical valve placed.  Her BP is 160/90. Is she a candidate for vasodilator therapy?

• A.

  No

• B.

  Yes

Which combination poses the greatest risk for thromboembolism?

• A.

  Aortic replacement with mechanical valve

• B.

  Aortic replacement with bioprosthetic valve

• C.

  Mitral replacement with mechanical valve

• D.

  Mitral replacement with bioprosthetic valve