Therapeutics Exam 4

1. .asflasd

stenosis

regurgitation

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

True

False

4. 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

True

False

>12h IF SYMPTOMATIC AND HEMODYNAMICALLY UNSTABLE. benefit unestablished. meh.

Explanation

>12h IF SYMPTOMATIC AND HEMODYNAMICALLY UNSTABLE. benefit unestablished. meh.

5. Clopidogrel has more rapid onset and more platelet inhibition than ticagrelor

True

False

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

Troponin

Myoglobin

CK-MB

CK

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

True

False

Causes an INCREASE in mortality

Explanation

Causes an INCREASE in mortality

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

I - warm and dry

II - warm and wet

III - cold and dry

IV - cold and wet

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

Digoxin

Metoprolol Tartrate

Metoprolol Succinate

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

True

False

attenuated response (weakened)

Explanation

attenuated response (weakened)

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

Failing a therapeutics test because of a poorly graded question

Getting in a fight with your parents

Jogging

Laying on the couch after a meal

Walking to your car in a blizzard

A. is emotional stress/anger
B. anger
C. physical exertion
E. physical exertion/cold

Explanation

A. is emotional stress/anger
B. anger
C. physical exertion
E. physical exertion/cold

12. Which combination poses the greatest risk for thromboembolism?

Aortic replacement with mechanical valve

Aortic replacement with bioprosthetic valve

Mitral replacement with mechanical valve

Mitral replacement with bioprosthetic valve

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

True

False

NE works by increasing SNS activity and plasma renin activity.

Explanation

NE works by increasing SNS activity and plasma renin activity.

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

Nifedipine

Cardizem

Diltiazem

Amlodipine

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

True

False

162 - 325 mg

Explanation

162 - 325 mg

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

True

False

30 minutes before or 2 hours after

Explanation

30 minutes before or 2 hours after

17. 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 ________.

2-3; life

2.5-3.5; life

2.5-3.5; 3 months

2-3; 3 months

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

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

BB

ACE-I

Diuretics

Aldosterone Antagonists

Diuretics are for fluid overload/symptom relief only

Explanation

Diuretics are for fluid overload/symptom relief only

20. 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?

No

Yes

Short-term to improve hemodynamic parameters before surgery

Explanation

Short-term to improve hemodynamic parameters before surgery

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

Dobutamine

Dopamine

Milrinone

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

Decreased or preserved

Preserved

Thickened

Hypertrophied

23. Loading dose/maintenance dose for ADP inhibitors:

Ticagrelor

Clopidogrel

Prasugrel

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24. The correct morphine dosing for UA/NSTEMI is:

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

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

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

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

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

True

False

Not recommended >75 due to increased bleeding risk

Explanation

Not recommended >75 due to increased bleeding risk

26. 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.

True

False

MUST take ambulance if he thinks he is having an event -- ambulances have defibrillators!

Explanation

MUST take ambulance if he thinks he is having an event -- ambulances have defibrillators!

27. 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

True

False

NO difference in mortality in stent vs meds (in stable ischemic heart disease - not an attack)

Explanation

NO difference in mortality in stent vs meds (in stable ischemic heart disease - not an attack)

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

Hyperlipidemia

Diabetes

HTN

CKD

LV systolic dysfunction

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

Long-acting nitrates

CCB

ACE-I

BB

30. Goals for treating PAD include:

Increasing maximum walking distance

Increasing duration of pain-free walking

Preventing critical limb ischemia

Improving co-morbid conditions

Improving quality of life

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

ST depression

T wave inversion

Q wave

Nothing

32. The recommended antithrombotic therapy for refractory IC is:

Clopidogrel 75 mg/day

ASA 81 mg/day

Clopidogrel 75 mg/day + cilostazol 100 mg BID

Cilostazol 100 mg BID

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

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

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

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

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

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

Mild

Borderline

Moderate

Severe

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

40 mg furosemide

2 mg bumetanide

10 mg torsemide

20 mg torsemide

1 mg bumetanide

Explanation

1 mg bumetanide

36. 2/3 of heart failure hospitalizations are due to MIs.

True

False

medication/lifestyle NONCOMPLIANCE

Explanation

medication/lifestyle NONCOMPLIANCE

37. Which is not a s/s of PAD?

Cool skin

Thick toenails

Pallor

Ulcers

Absent peripheral pulse

Lower-limb edema

Lack of hair on lower extremities

38. 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

None

Urgent work-up

Emergency surgery

Amputation

39. A BNP level of 453 is considered:

Mild

Moderate

Severe

mild > 300, mod >600

Explanation

mild > 300, mod >600

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41. Which are risk factors for carotid atherosclerotic disease?

Age >50

Cigarette smoking

DM

HTN

HLD (hyperlipidemia)

Inactivity

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42. Match the metabolic regulator to its function:

Nitric Oxide

Endothelin-1

Adenosine

Prostacyclin (PGI2)

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

Dopamine

Dobutamine

NTG

Milrinone

44. Which are considered non-modifiable CHD risk factors:

Type 2 Diabetes

Being 70

Premature menopause

LDL of 120

HDL of 39

Your grandpa had a heart attack at 55

Your mother had coronary ischemia at 59

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

80 mg furosemide IV

80 mg furosemide IV + continuous IV infusion

Nothing, this is sufficient urine output

80 mg furosemide IV + oral metolazone

80 mg furosemide IV + IV HCTZ

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46. Symptoms for Aortic Stenosis include:

Hemoptysis

Atypical CP

Palpitations

Orthopnea

Fatigue

Dyspnea on exertion DOE

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47. Which are counseling points when dispensing SL NTG?

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

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

Discard every 6 months

May cause an increase in heart rate

May be used as an analgesic

Take while sitting down

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48. Which are negative inotropic medications?

Doxorubicin

Some BBs

CCB

Terbinafine

Amphetamines

COX2 inhibitors

Antiarrhythmics

Imatinib

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