APEA FNP CARDIO EXAM QUESTIONS
AND CORRECT ANSWERS| LATEST
UPDATE
A common lab findings with ACE Inhibitors
ANSWER: Increase K+
ACE inhibitor =
retention of potassium.
Measure potassium one month after starting and one month after changing a
dose
What should you do?
Pt on Monopril and HCTZ for hypertension. His blood pressure is 160-170/92-98
on several blood pressure checks
Would you add an ARB?
If these are at maximum doses, consideration should be given to adding a
medication from a different class.
CALCIUM CHANNEL BLOCKER
NOT ARB - Adding an ARB may result in a precipitous decrease in his blood
pressure because he takes an ACE inhibitor and both of these medications work
in the renin-angiotensin-aldosterone system.
,Significance of sildenafil and any blood pressure meds
Any antihypertensive medication ... could have an additive effect with sildenafil
(or another medication in this
A specific drug-drug interaction to be aware of is the one that can occur with
sildenafil and alpha blockers like tamsulosin, alfuzosin, prazosin, doxazosin, or
terazosin. This combination of medications may increase the risk of
symptomatic hypotension because the effect of these two drugs is additive
Consider two meds
low dose HCTZ and ARB or ace
This patient's blood pressure goal is < 140/90 according to JNC VIII. Since he is
more than 20 points above systolic goal (or greater than 10 points above
diastolic goal) it is reasonable to consider two medications
Risk assessment for dyslipidemia- what age to start assessment
Start at age 2
Dyslipidemia assessment does not necessarily mean a Dyslipidemia assessment
refers to assessing family history of dyslipidemia, premature cardiovascular
disease, or diabetes, body mass index > 85% for age and sex, or history of other
systemic diseases like Kawasaki Disease or treatment, or renal disease.
When to start lipid profiles
recommended between 18 and 21 years of age.
,A patient taking an ACE inhibitor should avoid:
No K supplements
ACE inhibitor potentially can produce hyperkalemia because its mechanism of
action is in the renin-angiotensin-aldosterone system where potassium is spared.
If potassium is taken in the form of potassium supplements, the effect will be
additive and the risk of hyperkalemia can be great.
An 80 year-old female who is otherwise well, has a blood pressure of 176/80.
How should she be managed pharmacologically?
CCB
This patient has isolated systolic hypertension (ISH). This is common in older
adults and is associated with tragic cardiac and cerebrovascular events. The drug
class of choice to treat these patients is a long-acting calcium channel blocker. The
class of calcium channel blockers recommended for ISH has the suffix "pine"
(amlodipine, felodipine, etc).
Remember
ISH = PINE
ACE inhibitor is specifically indicated in patients who have ...
hypertension, diabetes with proteinuria, heart failure.
, 77 year-old patient has had an increase in blood pressure since the last exam.
The blood pressure has risen to 168/88 with 2 readings. The last exam's reading
was 144/90. If medication is to be started on this patient, what would be a good
first choice?
CCB
This patient is 77 years old and should have a goal blood pressure of < 150/90. A
thiazide diuretic is not a good first choice in this patient because it will not be
potent enough to decrease blood pressure by 25 points to get him to goal. A long
acting calcium channel blocker is appropriate for patients with isolated systolic
hypertension and will be more likely to get this patient to goal pressure than HCTZ.
Beta-blockers are no longer recommended first line for uncomplicated
hypertension. ACE inhibitors are very effective in patients who are high renin
producers. Elderly patients tend to produce lower amounts of renin.
A 63 year-old male has been your patient for several years. He is a former
smoker who takes simvastatin, ramipril, and an aspirin daily. His blood pressure
and lipids are well controlled. He presents to your clinic with complaints of
fatigue and "just not feeling well" for the last few days. His vital signs and exam
are normal. What should be done next?
Order a CBC and consider waiting a few days if normal.
Inquire about feelings of depression and hopelessness.
Order a CBC, metabolic panel, TSH, and urine analysis.
Order a B12 level, TSH, CBC, and chest x-ray
Order CBC, BMP, TSH, u/a
AND CORRECT ANSWERS| LATEST
UPDATE
A common lab findings with ACE Inhibitors
ANSWER: Increase K+
ACE inhibitor =
retention of potassium.
Measure potassium one month after starting and one month after changing a
dose
What should you do?
Pt on Monopril and HCTZ for hypertension. His blood pressure is 160-170/92-98
on several blood pressure checks
Would you add an ARB?
If these are at maximum doses, consideration should be given to adding a
medication from a different class.
CALCIUM CHANNEL BLOCKER
NOT ARB - Adding an ARB may result in a precipitous decrease in his blood
pressure because he takes an ACE inhibitor and both of these medications work
in the renin-angiotensin-aldosterone system.
,Significance of sildenafil and any blood pressure meds
Any antihypertensive medication ... could have an additive effect with sildenafil
(or another medication in this
A specific drug-drug interaction to be aware of is the one that can occur with
sildenafil and alpha blockers like tamsulosin, alfuzosin, prazosin, doxazosin, or
terazosin. This combination of medications may increase the risk of
symptomatic hypotension because the effect of these two drugs is additive
Consider two meds
low dose HCTZ and ARB or ace
This patient's blood pressure goal is < 140/90 according to JNC VIII. Since he is
more than 20 points above systolic goal (or greater than 10 points above
diastolic goal) it is reasonable to consider two medications
Risk assessment for dyslipidemia- what age to start assessment
Start at age 2
Dyslipidemia assessment does not necessarily mean a Dyslipidemia assessment
refers to assessing family history of dyslipidemia, premature cardiovascular
disease, or diabetes, body mass index > 85% for age and sex, or history of other
systemic diseases like Kawasaki Disease or treatment, or renal disease.
When to start lipid profiles
recommended between 18 and 21 years of age.
,A patient taking an ACE inhibitor should avoid:
No K supplements
ACE inhibitor potentially can produce hyperkalemia because its mechanism of
action is in the renin-angiotensin-aldosterone system where potassium is spared.
If potassium is taken in the form of potassium supplements, the effect will be
additive and the risk of hyperkalemia can be great.
An 80 year-old female who is otherwise well, has a blood pressure of 176/80.
How should she be managed pharmacologically?
CCB
This patient has isolated systolic hypertension (ISH). This is common in older
adults and is associated with tragic cardiac and cerebrovascular events. The drug
class of choice to treat these patients is a long-acting calcium channel blocker. The
class of calcium channel blockers recommended for ISH has the suffix "pine"
(amlodipine, felodipine, etc).
Remember
ISH = PINE
ACE inhibitor is specifically indicated in patients who have ...
hypertension, diabetes with proteinuria, heart failure.
, 77 year-old patient has had an increase in blood pressure since the last exam.
The blood pressure has risen to 168/88 with 2 readings. The last exam's reading
was 144/90. If medication is to be started on this patient, what would be a good
first choice?
CCB
This patient is 77 years old and should have a goal blood pressure of < 150/90. A
thiazide diuretic is not a good first choice in this patient because it will not be
potent enough to decrease blood pressure by 25 points to get him to goal. A long
acting calcium channel blocker is appropriate for patients with isolated systolic
hypertension and will be more likely to get this patient to goal pressure than HCTZ.
Beta-blockers are no longer recommended first line for uncomplicated
hypertension. ACE inhibitors are very effective in patients who are high renin
producers. Elderly patients tend to produce lower amounts of renin.
A 63 year-old male has been your patient for several years. He is a former
smoker who takes simvastatin, ramipril, and an aspirin daily. His blood pressure
and lipids are well controlled. He presents to your clinic with complaints of
fatigue and "just not feeling well" for the last few days. His vital signs and exam
are normal. What should be done next?
Order a CBC and consider waiting a few days if normal.
Inquire about feelings of depression and hopelessness.
Order a CBC, metabolic panel, TSH, and urine analysis.
Order a B12 level, TSH, CBC, and chest x-ray
Order CBC, BMP, TSH, u/a
