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NR 603 Week 3 Quiz : Possible Questions &
Answers
Per 2013 ACC/AHA guidelines, which patient below would NOT benefit from statin therapy?
- 42 yo male, LDL 162 mg/dL, 10 yr risk 4.9%
Which of the following patients should be on high-intensity statin therapy, if tolerated?
58 yo male w/ NSTEMI
- 71 yo female w/ DM, HTN, 10 yr risk 11.5%
- 41 yo male w/ baseline LDL 206 mg/dL
- 64 yo female w/ history of CVA
- All of the above
For someone who is intolerant to higher doses of statins, has tried 2-3 statins...what do we
recommend?
There's no true guidelines on how many different statins to try before moving on to non-
statin therapies, but generally should try 3-4 different statins that differ in metabolism,
hydro/lipophilic...and consider alternate day dosing or twice a week dosing.
You have a patient with ASCVD but no comorbidities. Their LDL has gone down 30% from
baseline and they are on maximally tolerated statin therapy.
Is this patient appropriate for non-statin therapy and if so, what do you recommend?
It is appropriate to consider non-statin therapy for this pt. b/c they have ASCVD.
Since their LDL has gone down <50% (or if their LDL >70/non-HDL >100), they should be given
ezetimibe 1st line. PCSK9 would be second line.
IG is a 47 yo male with CAD s/p MI 2015. He is currently prescribed atorvastatin 20 mg/day. Pt
states he is unable to tolerate higher doses and refuses to try another statin. LDL 114 mg/dL.
What is the next best step?
Alirocumab
YZ is a 67 yo female with DM and 10 year risk score 11.1%. She is currently prescribed
atorvastatin 80 mg once daily with reported adherence. Current LDL-C 141 mg/dL. What is the
next best step for cardiovascular risk reduction.
ezetimibe 10 mg once daily
TL is a 52 yo black male overbooked in your clinic today for evaluation of fasting labs per
primary provider request. He is without complaints.
Pertinent medications include amlodipine 10 mg/day and atorvastatin 20 mg/day
+ tobacco use, 3-4 beer/night Labs: TC 302, HDL 21, TG 1167, direct LDL 152, SCr 1.1
BP 145/78, height 74 inches, weight 113.4 kg
Increase atorvastatin to 40 mg/day
Start niacin ER 500 mg/day and titrate by 500 mg every month to target 2000 mg/day
Which of the following drugs inhibits factor IIa (thrombin) and factor Xa by activating
antithrombin?
Heparin
, 2
Which of the following drugs have pharmacogenomic information in the FDA label? Select all
correct answers (there may be more than one).
A. Clopidogrel B. Atorvastatin C. Metoprolol D. Warfarin. (they all do)
Variants in which of the following genes have the most compelling evidence for association with
clopidogrel response?
CYP2C19
Brown a 45-year-old African American male has elevated lipids. What should the nurse
practitioner do next?
*A thyroid stimulating hormone (TSH) level
Which of the following medications may have an unfavorable effect on a hypertensive patient's
blood pressure?
Naproxen
Which group of medications would be detrimental if used to treat a patient who has heart failure
Verapamil
A patient with hypertension has been diagnosed with gout. Which home medication may have
contributed to this episode of gout?
Diuretics such as furosemide
Which of the following class of drugs is preferred treatment for a diabetic with stage II
hypertension?
Angiotensin converting enzyme inhibitor
You are caring for a 30-year-old white male in your office with a BP of 144/90. He has never had
a diagnosis of hypertension. He doesn't check his blood pressure at home. He has a family
history of hypertension. What are your recommendations?
Instruct to purchase a BP cuff, record blood pressures, call if over 140's over 90's, low
salt diet, return in 2 weeks.
You are treating a young adult female with HTN and migraine headaches. Which class of
medications could you choose to treat both?
Beta blockers
A 42-year-old male presents with the following lipid profile. He is not on any medications for
cholesterol or herbal supplements.
Total: 210
LDL: 145
TG 162
HDL 52
What medication would you recommend?
low dose statin
You are caring for a 68-year-old male who has been taking atorvastain (Lipitor) for 8 weeks. He
complains of fatigue, muscle aches, and dark-colored urine. Which of the following is the most
appropriate treatment plan?
Order lipid level and serum creatine phosphokinase (CPK, creatine kinase).
What would you advise this patient regarding taking his atrovastatin (Lipitor)?
Stop taking atorvastatin until the labs are available.
NR 603 Week 3 Quiz : Possible Questions &
Answers
Per 2013 ACC/AHA guidelines, which patient below would NOT benefit from statin therapy?
- 42 yo male, LDL 162 mg/dL, 10 yr risk 4.9%
Which of the following patients should be on high-intensity statin therapy, if tolerated?
58 yo male w/ NSTEMI
- 71 yo female w/ DM, HTN, 10 yr risk 11.5%
- 41 yo male w/ baseline LDL 206 mg/dL
- 64 yo female w/ history of CVA
- All of the above
For someone who is intolerant to higher doses of statins, has tried 2-3 statins...what do we
recommend?
There's no true guidelines on how many different statins to try before moving on to non-
statin therapies, but generally should try 3-4 different statins that differ in metabolism,
hydro/lipophilic...and consider alternate day dosing or twice a week dosing.
You have a patient with ASCVD but no comorbidities. Their LDL has gone down 30% from
baseline and they are on maximally tolerated statin therapy.
Is this patient appropriate for non-statin therapy and if so, what do you recommend?
It is appropriate to consider non-statin therapy for this pt. b/c they have ASCVD.
Since their LDL has gone down <50% (or if their LDL >70/non-HDL >100), they should be given
ezetimibe 1st line. PCSK9 would be second line.
IG is a 47 yo male with CAD s/p MI 2015. He is currently prescribed atorvastatin 20 mg/day. Pt
states he is unable to tolerate higher doses and refuses to try another statin. LDL 114 mg/dL.
What is the next best step?
Alirocumab
YZ is a 67 yo female with DM and 10 year risk score 11.1%. She is currently prescribed
atorvastatin 80 mg once daily with reported adherence. Current LDL-C 141 mg/dL. What is the
next best step for cardiovascular risk reduction.
ezetimibe 10 mg once daily
TL is a 52 yo black male overbooked in your clinic today for evaluation of fasting labs per
primary provider request. He is without complaints.
Pertinent medications include amlodipine 10 mg/day and atorvastatin 20 mg/day
+ tobacco use, 3-4 beer/night Labs: TC 302, HDL 21, TG 1167, direct LDL 152, SCr 1.1
BP 145/78, height 74 inches, weight 113.4 kg
Increase atorvastatin to 40 mg/day
Start niacin ER 500 mg/day and titrate by 500 mg every month to target 2000 mg/day
Which of the following drugs inhibits factor IIa (thrombin) and factor Xa by activating
antithrombin?
Heparin
, 2
Which of the following drugs have pharmacogenomic information in the FDA label? Select all
correct answers (there may be more than one).
A. Clopidogrel B. Atorvastatin C. Metoprolol D. Warfarin. (they all do)
Variants in which of the following genes have the most compelling evidence for association with
clopidogrel response?
CYP2C19
Brown a 45-year-old African American male has elevated lipids. What should the nurse
practitioner do next?
*A thyroid stimulating hormone (TSH) level
Which of the following medications may have an unfavorable effect on a hypertensive patient's
blood pressure?
Naproxen
Which group of medications would be detrimental if used to treat a patient who has heart failure
Verapamil
A patient with hypertension has been diagnosed with gout. Which home medication may have
contributed to this episode of gout?
Diuretics such as furosemide
Which of the following class of drugs is preferred treatment for a diabetic with stage II
hypertension?
Angiotensin converting enzyme inhibitor
You are caring for a 30-year-old white male in your office with a BP of 144/90. He has never had
a diagnosis of hypertension. He doesn't check his blood pressure at home. He has a family
history of hypertension. What are your recommendations?
Instruct to purchase a BP cuff, record blood pressures, call if over 140's over 90's, low
salt diet, return in 2 weeks.
You are treating a young adult female with HTN and migraine headaches. Which class of
medications could you choose to treat both?
Beta blockers
A 42-year-old male presents with the following lipid profile. He is not on any medications for
cholesterol or herbal supplements.
Total: 210
LDL: 145
TG 162
HDL 52
What medication would you recommend?
low dose statin
You are caring for a 68-year-old male who has been taking atorvastain (Lipitor) for 8 weeks. He
complains of fatigue, muscle aches, and dark-colored urine. Which of the following is the most
appropriate treatment plan?
Order lipid level and serum creatine phosphokinase (CPK, creatine kinase).
What would you advise this patient regarding taking his atrovastatin (Lipitor)?
Stop taking atorvastatin until the labs are available.
