MSN 623 Final Questions With Complete
Solutions
Who are ACEIs recommended for?
All symptomatic patients with chronic stable
angina to prevent MI or death and to reduce
symptoms
Who are ACEIs contraindicated in?
African American patients
When using ACEI and spironolactone what needs to
be checked?
Spironolactone used for increase BP and fluid
retention (edema) and increases levels of
aldosterone
Need to check BP, HR, weight gain, urine output,
cough, dyspnea
Monitor BUN, Cr, Na, K+, and Mg+, uric acid and
glucose levels
Define Stage I uncomplicated HTN w/new renal
insufficiency
Stage I SBP: 140-159 mmHg/ DBP 90-99 mmHg
Diuretics: thiazide type
May consider ACEI, ARB, CCB, or combo
**diuretics always first line
When is the best time to take Fluoxetine (Prozac)?
,In the morning
Half life is 1-3 days
What are some common reasons for drug
noncompliance in elderly?
Forgetfulness, lack of planning, access, cost, side
effects altered dosing
Lifestyle modifications for HTN
"Diet: low salt, low fat, low calorie
Reduced smoking
Reduced alcohol intake
Weight loss
Exercise"
What has a long term effect on memory in elderly
patients?
Benzodiazepines
What has a short term effect on memory of elderly
patients?
Delirium - causing medications
i.e. some BZD, antihistamines (benadryl), opioids,
surgical meds, and anticholinergics
What do you need to be cautious with
Spironolactone?
, Hyperkalemia because kidneys cannot get out
excess potassium in a renal deficient patient
First line med use for ACUTE alcohol withdrawal
Benzodiazepines
Second line use for ACUTE alcohol withdrawal
Anticonvulsants
(i.e. carbamazepine)
Third line med use for ACUTE alcohol withdrawal
Adrenergics agonist
(i.e. clonidine or propranolol)
Fourth line med use for ACUTE alcohol withdrawal
Thiamine and magnesium
(alcoholics deficient in vit B12; wernicke's
syndrome)
CIWA-Ar
Clinical Institute Withdrawal Assessment of Alcohol
Scale, Revised
9 item symptom rating scale, max score 67; <10
does not warrant intervention
When is inpatient management required for CIWA-
Ar?
History of seizure
Severe withdrawal
Solutions
Who are ACEIs recommended for?
All symptomatic patients with chronic stable
angina to prevent MI or death and to reduce
symptoms
Who are ACEIs contraindicated in?
African American patients
When using ACEI and spironolactone what needs to
be checked?
Spironolactone used for increase BP and fluid
retention (edema) and increases levels of
aldosterone
Need to check BP, HR, weight gain, urine output,
cough, dyspnea
Monitor BUN, Cr, Na, K+, and Mg+, uric acid and
glucose levels
Define Stage I uncomplicated HTN w/new renal
insufficiency
Stage I SBP: 140-159 mmHg/ DBP 90-99 mmHg
Diuretics: thiazide type
May consider ACEI, ARB, CCB, or combo
**diuretics always first line
When is the best time to take Fluoxetine (Prozac)?
,In the morning
Half life is 1-3 days
What are some common reasons for drug
noncompliance in elderly?
Forgetfulness, lack of planning, access, cost, side
effects altered dosing
Lifestyle modifications for HTN
"Diet: low salt, low fat, low calorie
Reduced smoking
Reduced alcohol intake
Weight loss
Exercise"
What has a long term effect on memory in elderly
patients?
Benzodiazepines
What has a short term effect on memory of elderly
patients?
Delirium - causing medications
i.e. some BZD, antihistamines (benadryl), opioids,
surgical meds, and anticholinergics
What do you need to be cautious with
Spironolactone?
, Hyperkalemia because kidneys cannot get out
excess potassium in a renal deficient patient
First line med use for ACUTE alcohol withdrawal
Benzodiazepines
Second line use for ACUTE alcohol withdrawal
Anticonvulsants
(i.e. carbamazepine)
Third line med use for ACUTE alcohol withdrawal
Adrenergics agonist
(i.e. clonidine or propranolol)
Fourth line med use for ACUTE alcohol withdrawal
Thiamine and magnesium
(alcoholics deficient in vit B12; wernicke's
syndrome)
CIWA-Ar
Clinical Institute Withdrawal Assessment of Alcohol
Scale, Revised
9 item symptom rating scale, max score 67; <10
does not warrant intervention
When is inpatient management required for CIWA-
Ar?
History of seizure
Severe withdrawal
