NRNP- 6566 WK1-5 Midterm LATEST
UPDATE 2024/2025
Identify when cardioversion is indicated and relevant testing that should occur prior to it
- CORRECT ANSWER Unstable afib / flutter causing RVR, MI, hypotension or heart
failure; WPW syndrome in a fib
TEE should always proceed DCCV to rule out valve disease or thrombus
Hypertension definition
- CORRECT ANSWER sustained BP of 140's over 90's for a sustained period of time
Stage 1 is 140-159; and 90-99 diastolic
Stage 2 is equal or greater than 160 over greater or equal to 100 diastolic
Essential hypertension
- CORRECT ANSWER unknown cause
95% cases; onset 25 years old - 55
Secondary hypertension- related to known cause or disease process. This could be
from estrogen uses, renal disease, pregnant, endocrine disorders
Isolated systolic blood pressure- hypertension and systolic blood pressure greater than
140 over 90
Effectively treated with diuretics and long-acting calcium channel blockers
Signs and symptoms of hypertension: headache in the morning, epitaxis,
lightheadedness, visual disturbances, S4 present related to left ventricular hypertrophy,
retinal changes, hematuria (which is rare)
Hypertensive urgency
- CORRECT ANSWER severely elevated blood pressure
180 over 110 or higher without progressive target organ dysfunction
signs and symptoms: severe headache, shortness of breath, epistaxis, severe anxiety
treatment includes Clonidine (alpha-adrenergic stimulant 0.2 mg initial dose, then 0.1
mg every hour until controlled or total of 0.8 mg
May experience sedation, possible rebound hypertension once stopped
Captopril - ACE dose of 12.5 to 25mg
Hypertensive emergency
- CORRECT ANSWER Severely elevated blood pressure
180 over 120
can occur with lower blood pressure if impending or progressive target organ
dysfunction ( example : encephalopathy, intracranial hemorrhage, acute myocardial
infarction, pulmonary edema with acute LV failure, unstable angina, dissecting aortic
aneurysm or eclampsia
First intervention - goal is to get blood pressure down to 160-180 or less than 105
diastolic. First drug choice is nicardipine 2.5 to 1.5 mg hour intravenously. Side effects
, include headache, hypotension, tachycardia, nausea/vomiting, fever, neck pain,
indigestion
Second medication is nipride 0.25 to 10 micrograms per kilogram per minute
intravenously. Side effects include brady or tachycardia, nausea, abdominal pain,
twitching, dizziness, headache, flushing, sweating, IV site irritation. This medication can
cause rapid profound hypotension. Do not give this medication longer than 72 hours as
there is a risk for cyanide poisoning.
Nitroglycerin- 5 to 220 micrograms a minute intravenously. Side effects include
dizziness, headache, hypotension, orthostatics, numbness/tingling, flushing,
nausea/vomiting
Other medications:
Esmolol hydrochloride
Lebetalol - commonly used with pregnant patients
Apresoline- do not give to patients with Coronary artery disease and aortic dissection.
this is a vasodilator, which decreases blood pressure but increases heart rate and
retains fluid
Minoxidil is another vasodilator. good for end stage renal patients
Fenolodopam
Hypertension medications based on history
- CORRECT ANSWER Non-African Americans can take thiazide diuretics, calcium
channel blockers, ace inhibitors, ARBs (grade B)
African Americans need thiazides, calcium channel blockers (grade b); grade c for
patient with diabetes mellitus
Adults equal to or greater than the age of 18 with chronic kidney disease- ace inhibitors,
ARBS grade b - regardless of race or other comorbidities
Describe cytochrome p450 system
- CORRECT ANSWER Cytochrome p450 system is a series of enzymes used to
metabolize medications
Inhibitors
- CORRECT ANSWER block metabolic activity from one or more CYP450 enzymes
Inducers
- CORRECT ANSWER increase CYP450 enzyme activity by increasing enzyme
synthesis
Describe effect on low and high albumin levels on active drug levels especially for drugs
that are highly protein bound
- CORRECT ANSWER Albumin is the plasma protein with the greatest capacity for
binding drugs. Binding plasma proteins affect drug distribution into tissues, because
only drug that is not bound is available to penetrate tissues, bind to receptors, and exert
activity. As free drug leaves the blood stream, more bound drug is released from
binding sites.
UPDATE 2024/2025
Identify when cardioversion is indicated and relevant testing that should occur prior to it
- CORRECT ANSWER Unstable afib / flutter causing RVR, MI, hypotension or heart
failure; WPW syndrome in a fib
TEE should always proceed DCCV to rule out valve disease or thrombus
Hypertension definition
- CORRECT ANSWER sustained BP of 140's over 90's for a sustained period of time
Stage 1 is 140-159; and 90-99 diastolic
Stage 2 is equal or greater than 160 over greater or equal to 100 diastolic
Essential hypertension
- CORRECT ANSWER unknown cause
95% cases; onset 25 years old - 55
Secondary hypertension- related to known cause or disease process. This could be
from estrogen uses, renal disease, pregnant, endocrine disorders
Isolated systolic blood pressure- hypertension and systolic blood pressure greater than
140 over 90
Effectively treated with diuretics and long-acting calcium channel blockers
Signs and symptoms of hypertension: headache in the morning, epitaxis,
lightheadedness, visual disturbances, S4 present related to left ventricular hypertrophy,
retinal changes, hematuria (which is rare)
Hypertensive urgency
- CORRECT ANSWER severely elevated blood pressure
180 over 110 or higher without progressive target organ dysfunction
signs and symptoms: severe headache, shortness of breath, epistaxis, severe anxiety
treatment includes Clonidine (alpha-adrenergic stimulant 0.2 mg initial dose, then 0.1
mg every hour until controlled or total of 0.8 mg
May experience sedation, possible rebound hypertension once stopped
Captopril - ACE dose of 12.5 to 25mg
Hypertensive emergency
- CORRECT ANSWER Severely elevated blood pressure
180 over 120
can occur with lower blood pressure if impending or progressive target organ
dysfunction ( example : encephalopathy, intracranial hemorrhage, acute myocardial
infarction, pulmonary edema with acute LV failure, unstable angina, dissecting aortic
aneurysm or eclampsia
First intervention - goal is to get blood pressure down to 160-180 or less than 105
diastolic. First drug choice is nicardipine 2.5 to 1.5 mg hour intravenously. Side effects
, include headache, hypotension, tachycardia, nausea/vomiting, fever, neck pain,
indigestion
Second medication is nipride 0.25 to 10 micrograms per kilogram per minute
intravenously. Side effects include brady or tachycardia, nausea, abdominal pain,
twitching, dizziness, headache, flushing, sweating, IV site irritation. This medication can
cause rapid profound hypotension. Do not give this medication longer than 72 hours as
there is a risk for cyanide poisoning.
Nitroglycerin- 5 to 220 micrograms a minute intravenously. Side effects include
dizziness, headache, hypotension, orthostatics, numbness/tingling, flushing,
nausea/vomiting
Other medications:
Esmolol hydrochloride
Lebetalol - commonly used with pregnant patients
Apresoline- do not give to patients with Coronary artery disease and aortic dissection.
this is a vasodilator, which decreases blood pressure but increases heart rate and
retains fluid
Minoxidil is another vasodilator. good for end stage renal patients
Fenolodopam
Hypertension medications based on history
- CORRECT ANSWER Non-African Americans can take thiazide diuretics, calcium
channel blockers, ace inhibitors, ARBs (grade B)
African Americans need thiazides, calcium channel blockers (grade b); grade c for
patient with diabetes mellitus
Adults equal to or greater than the age of 18 with chronic kidney disease- ace inhibitors,
ARBS grade b - regardless of race or other comorbidities
Describe cytochrome p450 system
- CORRECT ANSWER Cytochrome p450 system is a series of enzymes used to
metabolize medications
Inhibitors
- CORRECT ANSWER block metabolic activity from one or more CYP450 enzymes
Inducers
- CORRECT ANSWER increase CYP450 enzyme activity by increasing enzyme
synthesis
Describe effect on low and high albumin levels on active drug levels especially for drugs
that are highly protein bound
- CORRECT ANSWER Albumin is the plasma protein with the greatest capacity for
binding drugs. Binding plasma proteins affect drug distribution into tissues, because
only drug that is not bound is available to penetrate tissues, bind to receptors, and exert
activity. As free drug leaves the blood stream, more bound drug is released from
binding sites.
