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Cardiology NP
Info & Q: NP EXAM
| Question | Answer |
|---|---|
| ID the BP: <120/<80 | Normal |
| ID the BP: 120-139 OR 80-89 | Pre-HTN |
| ID the BP: 140-159 OR 90-99 | Stage 1 HTN |
| ID the BP: >160 OR >100 | Stage 2 HTN |
| How do we tx Pre-HTN? | Diabetic - Yes Other healthy pt - lifestyle mod |
| Goal for BP in Main St. population? | Less than 140 over less than 90 |
| Goal BP for Diabetics and renal pt. | Less than 130 over less than 80 |
| pril | ACE inhibitor |
| sartan | ARB |
| lol | beta blocker |
| pine | Long acting calcium channel blocker |
| Go to drug for pt with HTN is? | diuretic |
| When do we dx HTN? | When we get 2 abnormal values |
| Pt comes in with sinus infection, blood pressure elevated can we dx HTN? | NO, need a second reading; pt with sinus infection may have taken sudafed so we need second reading |
| How do we manage pt with elevated BP on visit? | Have pt return to clinic to get second reading |
| When pt returns to clinic for BP check, his BP is elevated, can we dx? (BP-148/88) How do we manage? | Yes; Stage 1 - lifestyle mod for 3 mos then start meds if needed |
| Describe the DASH diet: | Low Na, High K+ (low K+ causes vasoconstriction), Hi Fruit and Veg, Hi Fiber |
| Upon Dx of HTN we need to get labs and baseline info for 3 important reasons: | 1. Target organ damage; ie LVH - HTN long time thus need aggressive manage 2. Do they have 2ndary HTN; ie TSH 3. Do they have any other risk factors? Hyperlipidemia, etc. |
| Management of HCTZ: initial dose, best effective dose, K+ considerations; May consider this drug to add to HCTZ if needed? | Initial dose HCTZ 25 mg daily; Best dose of HCTZ is "mid" range (increase to 50 not effective); Increase to 50 may cause more loss of K+ thus vasoconstriction; ACE (holds on to K+) |
| After starting pt on meds for HTN when should he return to clinic and what do we do? | Return in 1 month (ACE receptors saturated) and obtain BUN, Cr, K+ (check kidneys) |
| If pt started on CCB when does he return? | Return in 2 Weeks |
| What is a SE in ACE inhibitors that occurs more commonly in AA (blacks)? | Angioedema (tongue may be swollen out of mouth; swelling in face; can happen on "any" dose from 2 to 2000) |
| A pt in clinic with 197/98 what do we do? | Dx Stage 2 HTN TODAY and start TWO drugs TODAY along with lifestyle mod |
| If the pt has a hx of Gout what drug should be avoided? | HCTZ (drive fluid out thus uric acid increase) |
| Pt with Gout, what do we give to manage HTN; can we give ACE and ARB? | NO; both work down stream process of kid thereby knocking out a major way for him to regulate his blood pressure so never use initially; Avoid CCB and BB (<<<HR); try the CCB and ACE (Good Combo) |
| If pt develops a dry cough while on an ACE what should we swith him to? | ARB |
| Isolated Systolic HTN (ISH) treatment? | Long Acting CCB - Amlodipine |
| Long Acting CCB "DHP" (dihydropyridine) | DHP Doesn't Hurt Pulse - good to give for ISH; suffix end in pine |
| Diurectics affect these problems so watch when Rx to pts: | Glucose, lipids, gout |
| Watch for pt on Opthamic BB being tx for glaucoma, so avoid this med for HTN: | Oral BB |
| BB might mask this sign or symptom in Diabetics: | Hypoglycemia (BB may be used to knock out nervous or jitters) thus avoid so tell them to look for diaphoresis |
| Longstanding HTN leads to: | CHF |
| The most sensitive measure that a pt is holding on to fluid is: | Weight |
| What is the drug of choice to tx CHF? | ACE, ACE, ACE because they decrease morbidity and mortality |
| What affect do NSAIDs have on CHF pt? | NSAIDs hold on to Na thus fluid thereby making things worse. |
| What drug recently received a black box warning for CHF pt? | Rosiglitazone (Avandia) |
| Target Lipid Levels: TC, HDL, LDL, Trigl | TC-less than 200; HDL-greater than 40 but less than 60; LDL-less than 130; Trigl-less than 150 |
| When trying to reduce pts TC we should give: | Statin |
| When trying to reduce pts LDL we should give: | Statin |
| When trying to increase pts HDL we should give: | Niacin |
| When trying to decrease pts Trigl we should give: | Bibrate (Gemfibrozil, fenofibrate) |
| If pt taking a statin for couple of mos c/o muscle aches. Could it be related to statin and what do we do? | yes; get a CK |
| Pt taking a statin for month or so and has elevated AST, when should we stop the statin? | When AST levels or 2-3 times higher than normal |
| If you hear a murmur and feel the carotid pulse at the same time then the murmur is? | Systolic |
| If you hear a murmur and the carotid is calm then the murmur is? | Diastolic |
| ID the murmur: Mitral Regurgitation | Systolic |
| ID the murmur: Physiologic Murmur | Systolic |
| ID the murmur: Aortic Stenosis | Systolic |
| ID the murmur: Mitral Valve Prolapse | Systolic |
| ID the murmur: Aortic Regurgitation | Diastolic (always bad) |
| ID the murmur: Mitral Stenosis | Diastolic (always bad) |
| Whenever you hear a murmur and the pt has a complaint ie: SOB | Significant murmur and refer |
| Aortic Stenosis (systolic murmur) symptoms; you should think Aortic Stenosis Complications (ASC): | ASC - Angina, Syncope, Chf |
| What type of BP do people with Aortic Stenosis have? | Narrow Pulse Pressure |
| A common complaint of pt with Aortic Regurgitation is? | I can feel my heart beating because it is interacting with the chest wall |
| What type of BP do people with Aortic Regurgitation have? | Wide Pulse Pressure |
| A common complaint and problem of pt with Mitral Stenosis is? | Dyspnea; Atrial fib b/c the chamber pushes against stenotic valve thus growing larger thereby stretching the muscle that will alter electrical conduction |
| A common complaint of pt with Mitral Valve Prolapse is? | Palpitations, chest pain with exercise, SVT; more common in younger women; symptomatic with coffee |
| When you see the word "click" you have to think? | Mitral Valve Prolapse |
| It a murmur goes away by standing or moving then it is generally? | A Good murmur; good sign |
| Atypical chest pain may occur in what type of pt? | Older female, diabetic |
| Which class of antihypertensive should be avoided in a pt that swims? (tennis, jogs, golfer that walks 18 holes) | Beta Blocker |
| Pt c/o pain when walking that goes away after resting, this is called "intermittent claudication". What should we check? | Pedal Pulse |
| How do we assess DVT? | Homan's Sign |
| In pt with CHF exacerbation we would hear which "heart gallop"? | S3 |
| A pt with varicose veins might also have? | bilateral orthostatic edema |
Created by:
dprest
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