MSN 624 EVALUATION EXAM ACTUAL QUESTIONS AND
SOLUTIONS GRADED A+
✔✔10 year CVD risk for 40-79 y/o with total cholesterol <320 mg/dL - ✔✔- stage 1 HTN:
<10% risk (reassess in 3-6 months - no medication)
- stage 1 HTN: >10% risk (start med and reassess in 1 month)
- stage 2 HTN: no calculation needed, begin 2 meds from different classes; reassess 1
month
✔✔First Line HTN Medication - ✔✔- thiazide OR
- CCB OR
- ACE OR
- ARB
✔✔Thiazide - ✔✔[first line treatment]
- chlorthalidone 12.5-100mg daily
✔✔Calcium Channel Blocker (CCB) - ✔✔[first line treatment]
- amlodipine
- cardizem
✔✔ACE Inhibitor - ✔✔[first line treatment]
- accupril
- lisinopril
- zestril
✔✔Angiotensin Receptor Blocker (ARB) - ✔✔[first line treatment]
- diovan
- losartan
- valsartan
✔✔ACE and ARB - ✔✔do NOT use together
✔✔Treatment of HTN if CHF Present - ✔✔- ACE
- ARB
- loop diuretic (if GFR low)
✔✔Treatment of HTN if A Fib Present - ✔✔- CCBs
- Beta Blockers
- ARB (can help prevent arrhythmia)
✔✔Treatment of Resistant HTN or Primary Aldosteronism - ✔✔spironolactone
✔✔Treatment of HTN with Ischemic HF - ✔✔beta blocker
, ✔✔Treatment of HTN with Aortic Insufficiency - ✔✔NO beta blocker or CCB
✔✔HTN Crisis - ✔✔- SBP > 180 DBP > 120
- do NOT lower BP too quickly, want to lower it over 24-48 hours
✔✔Elderly HTN Management - ✔✔- treatment goal is < 130 systolic
- avoid starting 2 medications together
✔✔When to FU after starting BP Medication - ✔✔1 month
✔✔Thiazide Drugs for HTN - ✔✔[first option]
more effective in older and black patients
1) hydrochlorothiazide 12.5-50mg daily
2) chlorothiazide 125-500mg 1 or 2 doses
2) chlorthalidone 12.5-50mg daily
3) indapamide 1.25-5mg daily
ALWAYS check potassium (may need to supplement)
✔✔Per JNC8 BP Recommendation for 60-79 y/o - ✔✔<150/90 for patients WITHOUT
kidney disease
✔✔Per JNC8 BP Recommendation for patients at increased CV risk - ✔✔<140/90
✔✔Per JNC8 BP Recommendation for ≥ 80 y/o - ✔✔<150/90
✔✔Per JNC8 BP Recommendation for DM or Kidney Disease - ✔✔<140/90
✔✔ACE Drugs - ✔✔- benazepril 10-40mg daily
- captopril 12.5-25mg BID - TID (max = 150mg/day)
- enalapril 5-40mg daily or 2 divided doses
- lisinopril 10-40mg daily
✔✔ARB Drugs - ✔✔- second choice if ACE not working or cough present
- candesartan cilexitil 8=32mg daily or 2 divided doses
- irbesartan 150-300mg daily
- losartan 25-100mg daily or 2 divided doses
✔✔Beta Blockers - ✔✔- acebutolol 200-800mg daily or 2 divided doses
- betaxolol 5-20mg daily
- bisoprolol 2.5-10mg daily
- carvedilol 6.25mg BID initially -> 12.5mg BID after 1-2 weeks
✔✔Calcium Channel Blockers (CCBs) - ✔✔- amlodipine 2.5-10mg daily
SOLUTIONS GRADED A+
✔✔10 year CVD risk for 40-79 y/o with total cholesterol <320 mg/dL - ✔✔- stage 1 HTN:
<10% risk (reassess in 3-6 months - no medication)
- stage 1 HTN: >10% risk (start med and reassess in 1 month)
- stage 2 HTN: no calculation needed, begin 2 meds from different classes; reassess 1
month
✔✔First Line HTN Medication - ✔✔- thiazide OR
- CCB OR
- ACE OR
- ARB
✔✔Thiazide - ✔✔[first line treatment]
- chlorthalidone 12.5-100mg daily
✔✔Calcium Channel Blocker (CCB) - ✔✔[first line treatment]
- amlodipine
- cardizem
✔✔ACE Inhibitor - ✔✔[first line treatment]
- accupril
- lisinopril
- zestril
✔✔Angiotensin Receptor Blocker (ARB) - ✔✔[first line treatment]
- diovan
- losartan
- valsartan
✔✔ACE and ARB - ✔✔do NOT use together
✔✔Treatment of HTN if CHF Present - ✔✔- ACE
- ARB
- loop diuretic (if GFR low)
✔✔Treatment of HTN if A Fib Present - ✔✔- CCBs
- Beta Blockers
- ARB (can help prevent arrhythmia)
✔✔Treatment of Resistant HTN or Primary Aldosteronism - ✔✔spironolactone
✔✔Treatment of HTN with Ischemic HF - ✔✔beta blocker
, ✔✔Treatment of HTN with Aortic Insufficiency - ✔✔NO beta blocker or CCB
✔✔HTN Crisis - ✔✔- SBP > 180 DBP > 120
- do NOT lower BP too quickly, want to lower it over 24-48 hours
✔✔Elderly HTN Management - ✔✔- treatment goal is < 130 systolic
- avoid starting 2 medications together
✔✔When to FU after starting BP Medication - ✔✔1 month
✔✔Thiazide Drugs for HTN - ✔✔[first option]
more effective in older and black patients
1) hydrochlorothiazide 12.5-50mg daily
2) chlorothiazide 125-500mg 1 or 2 doses
2) chlorthalidone 12.5-50mg daily
3) indapamide 1.25-5mg daily
ALWAYS check potassium (may need to supplement)
✔✔Per JNC8 BP Recommendation for 60-79 y/o - ✔✔<150/90 for patients WITHOUT
kidney disease
✔✔Per JNC8 BP Recommendation for patients at increased CV risk - ✔✔<140/90
✔✔Per JNC8 BP Recommendation for ≥ 80 y/o - ✔✔<150/90
✔✔Per JNC8 BP Recommendation for DM or Kidney Disease - ✔✔<140/90
✔✔ACE Drugs - ✔✔- benazepril 10-40mg daily
- captopril 12.5-25mg BID - TID (max = 150mg/day)
- enalapril 5-40mg daily or 2 divided doses
- lisinopril 10-40mg daily
✔✔ARB Drugs - ✔✔- second choice if ACE not working or cough present
- candesartan cilexitil 8=32mg daily or 2 divided doses
- irbesartan 150-300mg daily
- losartan 25-100mg daily or 2 divided doses
✔✔Beta Blockers - ✔✔- acebutolol 200-800mg daily or 2 divided doses
- betaxolol 5-20mg daily
- bisoprolol 2.5-10mg daily
- carvedilol 6.25mg BID initially -> 12.5mg BID after 1-2 weeks
✔✔Calcium Channel Blockers (CCBs) - ✔✔- amlodipine 2.5-10mg daily
