APEA 3P EXAM QUESTIONS with VERIFIED ANSWERS 100% (NEW 2024), Study Guides, Projects, Research of Nursing

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APEA 3P EXAM QUESTIONS with VERIFIED ANSWERS 100% (NEW 2024) Most common type of skin cancer in USA Skin cancer Most common type of skin cancer basal cell carcinoma basal cell carcinoma symptoms Appearance varies; smooth, shiny bump, pink to pearly white Basal cell carcinoma common locations cheeks, nose, face, neck, arms, back basal cell carcinoma diagnosis gold standard biopsy. if not an option, refer to derm Actinic keratosis Precursor to squamous cell carcinoma numerous dry, round and pink to red lesions w/ rough and scaly texture --> does not heal, slow growing in sun exposed areas Actinic keratosis diagnosis gold standard Biopsy. if not an option, refer to derm Actinic keratosis treatment gold standard small- cryotherapy large- number 5-FU (5-flouracil aka efudex). 5-FU medication Causes skin to ooze, crust, scab and be red *5-flouracil/ efudex-wear sunscreen!!* squamous cell cancer chronic red scaly rough textured lesion w/ irregular borders crusting or bleeding may be present Squamous cell carcinoma common locations rims of ears, lips, nose, face and top of hands precursor lesion to squamous cell cancer actinic keratosis squamous cell carcinoma diagnosis by? biopsy gold standard. if biopsy is not an option, refer to dermatology. Risk factors for skin cancer (melanoma and both non-melanoma) Blistering sunburn as a child, history of sunburns, light skin, chronic exposure to UV light (sunlight/tanning beds), moles, family hx for skin cancer **AVOID RIFAMPIN IN PREGNANCY Brudzinkski sign (meningeal irritation) Tests for meningeal irritation Patient supine, raise BACK of head and flex chin towards chest + result if pt automatically beds both hips --Brudzinski and back of head start with B as well as bends-- Kernig's sign Tests for meningeal irritation patient supine. flex patients hips and knees in a right angle, then slowly straighten/extend the legs up + result if when the patient complains of pain during extension of leg MCV4 (meningococcal vaccine) Age 11-19 Give one dose of menactra or menveo primary dose given age 12 or younger give a booster at age 16-18 MCV4 (meningococcal vaccine) Age 19-21 Give one dose of menactra or menveo if never had either Rocky mountain spotted fever (RMSF) symptoms Fever chills N/V myalgia arthralgia 2-5 days later develop petechial rash on forearms, ankles, and wrists that spreads towards trunk and becomes generalised. sometimes rash develops on palms and soles *RASH DEVELOPS INWARDS* RMSF pneumonic (RMSF) R-Rash M-Muscle aches (myalgia) S-Stomach aches (nausea and vomiting) F-Fever (>102 F) Rocky Mountain Spotted Fever (RMSF): Located: •Think "Rocky"- North Carolina, Oklahoma, Arkansas, Tennessee, Missouri Spring to Fall (April to September) Rocky Mountain Spotted Fever (RMSF): DX PCR assay by indirect immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia Rickettsii Rocky Mountain Spotted Fever (RMSF): tx Doxycycline is always first line for all ages 100 mg every 12 hours x 7-10 days Can be fatal if not treated within the first 5 days Erythema Migrans (early Lyme disease): Symptoms Usually appears in 7-14 days after being bitten by a deer tick; range 3-30 days Target bull's-eye Rash is hot to touch with rough texture. Expanding red rash with central clearing • Common locations are belt line, axillary area, behind the knees, and groin area • Positive for flu like symptoms. Lesions and rash resolve within a few weeks with or without treatment Erythema Migrans (early Lyme disease): DX Dx: • First step is enzyme immunoassay (EIA) also knows as ELISA if negative no further testing needed. If positive confirm with Western Blot test (aka indirect immunofluorescence assay (IFA) for Borrelia Burgdorferi 1. Enzyme immunoassay 2. western blot test (immunoflurorescence assay/ IFA) Exam Tip: E before I Nodule raised solid lesion (BCC) Plaque solid raised lesion with flat top (psoriasis) Bulla/Bullae elevated superficial blister filled with serous fluid (2nd degree burn, impetigo) Pustule circumscribed elevated lesion containing pus (acne pustules) Secondary Skin Lesions-Lichenification thickening of the epidermis with exaggeration of normal skin due to chronic skin itching (eczema) Secondary skin lesions- Scale flaking skin (psoriasis) Secondary skin condition-crust dried exudate (impetigo) Secondary skin condition-ulceration eroding of epidermis and dermis (if deep can involve subcutaneous tissue) Secondary skin condition-scar permanent fibrotic change following damage to dermis (surgical scars) Secondary skin condition-keloids/hypertrophic scars overgrowth of scar tissue (more common in Black and Asian descent) Rule of 9's Head and neck = 9% Upper Ex = 9% each Lower Ex = 9% each Front trunk = 18% Back trunk = 18% Rule of 9's =-child leg Chlid one leg=13.5% One leg adult =18% Rule of 9's =child head Child head- 18% (half of adult %) First degree (superficial): Red to bright red skin and tenderness/pain second-degree (partial-thickness) burns Painful red skin, bullae (blisters), reddened/weepy skin --> BLISTERS START AT SECOND DEGREE third-degree (full-thickness) burns Pain sensation absent. Pale/white color, charred skin, leather-like texture Criteria for Burn Center Referral: Face, hands, feet, genitals, major joints Electrical burns, lightning burns Partial thickness burns >10% of total body surface area Third degree burns in any age group If pt. has a Sulfa allergy and can't use Silvadene what is the alternative? Bacitracin, Polysporin/Triple antibiotic cream or ointment Cellulitis Bacteria (Gram Positive): Streptococcus (beta hemolytic strep), Staph aureus (MRSA) Cellulitis Symptoms: Diffused pink to red colored skin, warm to touch, and may become abscessed If red streaks radiating from infection it has spread to lymph nodes (lymphangitis) Usually within the deep dermis and is poorly demarcated (poor boundaries) Most common location is the lower legs -->If pt. has DM and develops cellulitis watch for osteomyelitis Cellulitis treatment Tetanus Vaccination Initial series (3 doses) DTaP (infants to age 6): 5 doses Ages 7 and older Td or Tdap Need every 10 years for lifetime Common reaction: pain at injection site in 24-48 hours Contaminated wounds: give one dose if last dose was more than 5 years ago or is due Impetigo Bacteria (Gram Positive): Beta Streptococcus or Streptococcus aureus Most common bacterial skin infection in young children ages 2-5 Impetigo symptoms Itchy pink-red lesions, evolve into vesiculopustules that rupture easily, honeycolored crusts (from dried serous exudate) Very pruritic and contagious Impetigo Treatment Order C&S of fluid Severe Case= Keflex or Dicloxacillin QID x 10 days Penicillin Allergy o Give Azithromycin 250 mg x 5 days or o Clindamycin x 10 days **If no blisters- topical mupirocin ointment (bactroban) 2% x 10 days Acne Vulgaris (common acne): treatment First line is always topical retinoid such as tretinoin cream (Retin-A) Acne: Mild treatmetn open comedones blackheads/closed comedones (whiteheads) w/ or w/o papules topical retinoid (Retin-A) *Acne will worsen during first 4-6 weeks* IF no improvement in 8-12 weeks, increase dose or ADD benzoyl peroxide and/or erythromycin Acne: Moderate (topicals plus antibiotics) papules and pustules with comedones (3 part treatment) Topical retinoid (Retin-A) AND topical benzoyl peroxide AND oral antibiotic (Tetracycline or Minocycline) x 3-4 weeks --> Exam usually asks about moderate Acne: Severe painful indurated nodule, cysts, abscesses, pustules Accutane- check Liver function tests (LFTS) must use 2 forms of contraceptives, monthly pregnancy testing only prescribe 1 month supply of medication Usually, will refer to Dermatology Topical retinoid side effects Irritation, dry skin, flaking, redness during first 4 weeks due to increase in skin turnover After washing face wait 30 minutes before applying medication to help minimize irritation Acne medications to avoid in pregnancy (category X &C) Category X: Topical tazarotene (Tazorac), Accutane Category C: Topical retinoids (tretinoin, adapalene) Acne Rosacea Symptoms: • Chronic small acne like papules/pustules, and telangiectasias around nose, mouth, and chin symmetrically • First Line: o Stop exposure to substance • Topical steroids QD to BID x 1-2 weeks • Consider referral to allergist for patch testing Scabies Pruritic rash located in the interdigital webs of the hands, axillae, breasts, buttock folds, waist, scrotum, and penis • Severe generalized itching that is worse at bedtime • Family member will have same symptoms o Apply cream to skin from neck to soles of feet. Leave on for at least 8-14 hours then rinse off. Repeat in 1 week o Scabies never go to scalp! o Treat everyone. Wash sheets and all other items in house in hot water --Scabies never go to scalp TREAT EVERYONE Pityriasis Rosea: Symptoms May be itchy Herald patch appears 2 weeks before full breakout Christmas tree pattern Rash on the hands or soles of the feet Pityriasis Rosea: Treatment Resolves on its own in about 4-6 weeks Test for secondary syphilis with RPR then VDRL as screening • If positive then do FTA- ABS if this is positive patient has syphilis; treat appropriately Tinea Corporis (body-think of core): symptoms Ring like itchy rash, slowly enlarges with central clearing Tinea Corporis (body-think of core): Treatment Most respond to topical antifungals, if severe do oral Lamisil Med ends with azole on exam Tinea Capitis (scalp-think of baseball cap): symptoms &Treatment Scaly round itchy patches on the scalp. Hair becomes fragile at the roots and breaks (black dot sign) Treatment: Oral meds only (Griseofulvin, terbinafine, fluconazole, or itraconazole) Obtain baseline LFT and repeat in 2 weeks o Gold standard: § Griseofulvin QD-BID x 6- 12 weeks Avoid hepatotoxic substances (alcohol, statins, acetaminophen) Avoid sharing combs, headgear, towels, pillows, and clothes with others Tinea Cruris (groin):symptoms and treatment Erythematous annular (ring-shaped) rash located in the groin area which can sometimes extend to buttocks Usually associated with tinea pedis Treatment: • Azole topical cream (Lamisil, Lotrimin, Monistat-Derm) x 7-14 days Tinea Pedis (Hands/Feet- think pedicure):symptoms and treatment Symptoms: • Scaling of the soles • Skin feels wet, strong odor, vesicles and bullae that rupture • "Two feet and one hand" disease (dominant hand used for itching the feet becomes infected) Treatment: Azole topical cream (Lamisil, Lotrimin, Monistat-Derm) x 7-14 days Onychomycosis aka tinea unguium (fingernail or toenail fungus): Symptoms and treatment Symptoms: Elderly with yellow-colored nails Thickened nails with debris Treatment: Mild cases fingernails: o Topical Penlac Toenails: Systemic antifungals either 6 weeks or pulse therapy (once per week for 3- 4 cycles) Position at 90 and apply steady pressure until you have blood draining Remove either the paperclip or needle and gently evacuate the blood Systemic Lupus Erythematosus: symptoms/treatment Symptoms: •Maculopapular butterfly-shaped rash on the middle of the face (malar rash) •May have nonpruritic thick scaly red rashes on sun-exposed areas Treatment: • Refer to rheumatology • Avoid sunlight and other UV light exposure can worsen the disease • Wear broad-spectrum sunblock that's effective against UVA and UVB Molluscum Contagiosum: cause/symptoms/tx Cause: • Poxvirus Symptoms: • White plug, dome shaped with central umbilication • Highly contagious (spreads via skin-to-skin contact) Treatment: • Typically resolves on its own if immunocompetent (watchful waiting) o Other options: cryotherapy, curettage, cantharidin • If sexually active CDC considers this an STI if in genital region Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN): symptoms Symptoms: • Classic is target or bull's-eye rash that occurs abruptly • Hives and blisters • Petechiae and purpura • Necrosis with sloughing of tissue • Extensive mucosal involvement • Prodrome of fever with flu like symptoms Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN): Triggers Mnemonic: SANA(p) • Sulfonamides • Anticonvulsants • NSAIDs • Allopurinol • PCN *HIV patients are at a higher risk for SJS & TEN* Acanthosis Nigricans: symptoms Velvety hyperpigmented patches most common on back of neck or skin folds • Usually associated with diabetes, metabolic syndrome, obesity, and cancer of the GI tract Scarlet Fever (Scarlatina): Symptoms "Sandpaper textured-pink rash with sore throat" Strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates (peels/sheds) Associated with strep throat Lichen Planus: symptoms & Treatment Symptoms: • Small flat topped, red to purple bumps that may have white scales/flakes • Wispy grey white streaks called Wickham's striae • Found on the inner wrists, forearms, and ankles. If on scalp causes hair loss • Can be found in vulva and vagina with soreness, burning, and rawness Treatment: Topical Steroids (even in vaginal area for Lichen Sclerosus) Anthrax: Symptoms & treatment Symptoms: Animals/hides/hair/wool Lesions begin as papules that enlarges quickly within 24-48 hrs. Develop necrosis and ulceration (sort of like a recluse spider bite) Not contagious Treatment: Doxycycline, Cipro, or Levaquin BID x 7-10 days If you suspect BIOTERRORISM treat for 60 days Treatment: • Hot compress QID if large otherwise no treatment Hordeolum (Stye): Symptoms and Treatment Symptoms: Painful • Swollen • Red, warm, abscess, and it's acute Think Hordeolum "Hurts" Treatment: • Hot compress until it drains QID • Avoid wearing eye make-up • Erythromycin or dicloxacillin QID if preseptal cellulitis develops 17 o Refer to ophthalmology for I&D Senile arcus: Symptoms and Treatment Symptoms: White-gray ring on edge of cornea in elderly and is bilateral Normal finding in elderly Result of lipid deposit Treatment: None Age less than 50 check lipid profile Xanthelasma: Symptoms and treatment/ DX Symptoms: • Soft yellow flat plaques on the upper and lower lids by the inner canthus or palpebrum • Cholesterol plaques Dx: • Order fasting lipid profile to rule out hypercholesteremia Treatment: • Trichloroacetic acid, surgery, laser Allergic Conjunctivitis (Keratoconjunctivitis): Symptoms & Treatment Symptoms: Typically, bilateral itchy eyes with "stringy discharge and increased tearing" Type I sensitivity (IgE) Rhinitis and allergic shiner Treatment: PO (oral) antihistamines Eye drops olopatadine (Patanol), Visine (short term or episodic use only) Cool compresses and avoid allergens *May be called keratoconjunctivitis on ANCC Bacterial Conjunctivitis: Symptoms and treatment Symptoms: • Acute onset of red eye • Dried yellow-green crusting on eyelids on awakening Treatment: Topical ophthalmic fluroquinolones (Ofloxacin) Q 2-4 hours x 2 days, then QID x 5 days Viral Conjunctivitis (Pink Eye): Symptoms and treatment Symptoms: • Acute onset of red eye • Complaint of itchy eyes; one or both eyes • Periauricular lymphadenopathy 18 • Very contagious Treatment: No treatment; frequent hand washing Keep away from school for 1 week Herpes Keratitis: Cause, symptoms, DX, TX Cause: Herpes Simples Virus or Shingles (Herpes Zoster) Symptoms: Abrupt onset of eye PAIN, blurred vision, and tearing, Vesicles and/or small rash on the temple on affected side Follows the V1 branch (ophthalmic branch) of the trigeminal nerve (CN V) Dx: Fluorescein dye o Shows "fern-like" lesion Treatment: Ophthalmologist or ER STAT Corneal Abrasion: Symptoms & DX & treatment & alternative meds Symptoms: Elderly with night vision issues Difficulty with glare (headlights when driving at night or sunlight) Halos around lights Screening: Red Reflex Test o If cataracts are present the red reflex will be missing from the affected eye(s) Normal is a reddish-orange glow If no glow, dull, or white; the reflection is abnormal Age-Related Macular Degeneration: Symptoms & Treatment Symptoms: Painless loss of "central vision" reports straight lines appear curved Periphery is preserved Leading cause of blindness in the elderly and more common in smokers Treatment: Give Amsler grid or refer to ophthalmologist if Amsler grid is not an option Retinal Detachment: Symptoms & Treatment Symptoms: Sudden onset of floaters Looking through the curtain Flashes of light Painless Treatment: ER STAT Dacryocystitis: background& symptoms & treatment Background: Infection of lacrimal sac/tear duct usually caused by blockage Common in infants, adults over 40 also have higher risk of developing Symptoms: Thick eye discharge, pain, redness/swelling/warmth of lower eyelid, watery eye/excess tearing Treatment: Lacrimal sac massage (downward toward mouth) 2-3 times daily; systemic antibiotics 7-10 days Allergic Rhinitis: Background & symptoms & treatment Background: Inflammatory changes of nasal mucosa due to allergies Atopic family history (asthma, eczema) May have seasonal or daily symptoms Symptoms: Chronic nasal congestion with clear mucus discharge or post nasal drip Itchy nose, Frequent sneezing, Coughing worsens when supine due to post nasal drip, Blue-tinged or pale boggy (spongy) nasal turbinate's Treatment: • First Line: Nasal steroid sprays (Fluticasone - Flonase) BID, triamcinolone (Nasacort Allergy) 1-2 sprays QD • Antihistamine Azelastine (Astelin) QD-BID • Decongestants Pseudoephedrine PRN. Avoid in infants and children • Avoid triggers Epistaxis (Nosebleed): Background & Treatment Background: Anterior nosebleed more common. Caused by bleeding at Kisselbach's plexus Treatment: Have the pt. blow their nose first Apply two sprays of topical nasal decongestant (Afrin). Pinch alae tightly against nasal septum and hold for 10 minutes Meniere's Disease: Symptoms Look for clear, golden serous discharge from the ear or nose treat immediately-Refer to ER Benign Paroxysmal Positional Vertigo (BPPV): Symptoms & DX & Treatment Symptoms: Vertigo lasting <1 minute caused by sudden head movements and position changes May lose balance and fall Due to calcium carbonate crystals (otoconia) being trapped in the semicircular canals Dx: Gold Standard: Dix-Hallpike Epley Maneuver in clinic or at home by pt Test won't ask how to conduct treatment just be able to associated Epley with BPPV Vestibular Neuritis and Labyrinthitis: Cause/ Symptoms/ TX Viral infection/Inflammation Symptoms: Sudden/rapid onset of severe vertigo with nausea/vomiting for 1-2 days and then symptoms lessen • Sensorineural hearing loss and tinnitus Treatment: Ondansetron (Zofran) Methylprednisolone taper Acute Otitis Media (AOM)(Think of Media for Middle Ear): Strain & symptoms & treatment Bacteria: Streptococcus pneumonia (others: Haemophilus influenza, Moraxella catarrhalis) High rate of beta-lactamase resistance Symptoms: Unilateral ear pain (otalgia) Popping noises, and muffled hearing, Either afebrile or low-grade fever, The tympanic membrane can rupture. Blood and pus can be seen on the pillow upon awakening with relief of ear pain ,TM will be red. Bulging and the cone of light will be abnormal or displaced ,Most objective finding: Decreased mobility per the tympanogram which will be a flat line Treatment: NO antibiotic use in the prior month: o Amoxicillin high dose (first line): 1000 mg TID x 5-7 days Next antibiotic choices are: 23 Augmentin x 5-7 days o Omnicef or cefpodoxime BID x 5-7 days Penicillin Allergy: Type 1 Allergy (anaphylaxis, angioedema): Levofloxacin 750 mg QD x 5-7 days OR Doxycycline BID x 5-7 days • Type 2 Allergy (skin rash): Omnicef, cefpodoxime, Ceftin BID x 5-7 days Hearing Tests: Conductive Hearing Loss Weber- Lateralization to bad ear Rinne- BC>AC Otitis Media with Effusion: Symptoms/TX/Hearing tests Symptoms: Usually, painless May follow AOM but can also be caused with chronic allergic rhinitis Sterile CLEAR serious fluid is trapped in the middle ear. May see air bubbles, Ear pressure along with mild hearing loss and ear popping sounds, TM should NOT BE RED. TM may bulge or retract Treatment: Treat like allergies Can do supportive care and wait 3 months • Oral decongestants o Pseudoephedrine or phenylalanine • Steroid nasal spray (Fluticasone - Flonase) BID-TID x few weeks or NSAIDs for pain Do not use antihistamines or decongestants Penicillin Allergy: Levofloxacin 750 mg QD x 5-7 days or Doxycycline BID x 5-7 days Infectious Mononucleosis: cause/sx/dx/tx Epstein Bar Virus (Herpes Virus Family) Symptoms: Sore throat with tonsillitis. May have whitish tonsillar exudates • Posterior lymphadenopathy • Severe fatigue present for many weeks • Maculopapular rash • Hepatomegaly and or splenomegaly Classic Triad: Fever, Pharyngitis, Lymphadenopathy Dx: • Monospot (heterophile antibody) Treatment: Symptomatic • Rest • Avoid contact sports and heavy lifting for at least 4-6 weeks. A Ruptured spleen is a rare but serious sequela of mono May do an abdominal US to clear patient for sports Test Tip: If the patient has strep throat and mono, avoid using Amoxicillin as the antibiotic of choice. The patient may develop a rash with this drug. Macrolides are a good option (Clarithromycin). Levofloxacin works as well but it is overkill Strep Throat:Cause, symptoms, TX Cause: • Group A streptococcal bacteria (Streptococcus pyogenes)• Most common cause of sore throat is viral (rhinovirus, adenovirus, RSV) • Strep is most common in school-aged children SX: • Abrupt onset of fever, sore throat, and pain on swallowing • Absence of viral symptoms (coryza, cough, hoarseness, runny nose, watery eyes) • Tender anterior cervical lymphadenopathy • Scarlatiniform rash (sandpaper rash) • Children: May have abdominal pain and diarrhea TX: First line-Pencillin V or amoxicillin suspension immediate or XR QD x10 days ANAPHYLAXIS HX: z pack or clindamycin Strep Throat, Nonpuruluent SSTI Risks o Rheumatic fever, scarlet fever, acute poststreptococcal glomerulonephritis, poststreptococcal reactive arthritis (develops within 1 month after strep) Strep throat, purulent risks • Suppurative (Pus): Tonsillopharyngeal abscess, cellulitis, OM, sinusitis Strep throat • Centor Criteria: • Be able to connect Centor Criteria with Strep Throat Fever (1 point) Anterior cervical lymphadenopathy (1 point) Tonsillar exudate (1 point) Absence of cough (1 point) Age 3-14 (1 point) Age 15-44 (0 points) Age >44 (-1 point) Score of 0-1 unlikely need to test for strep; score of 3-4 confirm with rapid strep test Hypertension Retinopathy S2 Heart sound diastolic murmurs are always PATHOLOGICAL-indicative of heart disease Mitral stenosis (Mid/late diastolic) Afib most common risk-emboli risk narrowing of the mitral valve Only murmur you listen to with your Bell *Dyspnea most common symptom* Heart Murmur Grading System: Grades I-VI : • Grade I: Barely audible • Grade II: Audible • Grade III: Clearly audible • Grave IV: First time thrill is present (more than likely will ask for this on exam) • Grade V:Hear the murmur even with edge of stethoscope off • Grade VI: Murmur is so loud that it can be heard with entire stethoscope off chest S3 sound associated with? Heart failure Sounds like "Kentucky" Abnormal in ages under 35 S3 is a normal heart sound in: Pregnancy, young children, athletes How to listen to S4 Bell of stethoscope Sounds like "Tennessee" Late diastole is when __Valves close; occurs in S1 Late diastole, S1, is when the AV valves close Late diastole is when __valves close; occurs in S2 Late diastole, S2, is when the SL valves close Motivated-S1 heart sound-Lub includes what valves Motivated (S1 heart sound-lub) M (mitral valve) T (tricuspid valve) AV (atrioventricular valves) Apples- s2 heart sound-dub-includes what valves A (aortic valve) P (pulmonic valve) S (semilunar valves) Isolated systolic hypertension (ISH) Systolic is 140+ and diastolic is 90 or less--occurs mainly in older adults HTN meds that cause heartburn CCB, BB, alpha agonists Atrial Fibrillation (AF) (Most common arrhythmia in the US) • Can be paroxysmal or persistent • Pt. will complain of the sudden onset of heart palpitations accompanied by weakness, dizziness, fatigue, and dyspnea • May have chest pain and feel like passing out Rapid and irregular pulse which may be greater than 110 per minute with hypotension --> Consider antithrombic therapy Afib diagnosis A diagnostic test is 12 lead ECG which won't show discrete P waves and will be irregularly irregular CHA2DS2-VASc score Hypertension: If Goal BP is not reached at __ month, increase the dose on the initial drug and/or add a second drug • If Goal BP is not reached at 1 month, increase the dose on the initial drug and/or add a second drug Thiazide diuretics; do not give to a patient with a _____ allergy Do not give thiazide diuretics to a patient who has a sulfa allergy Ace inhibitors -pril: HTN, HF. AD: angioedema, cough, hypotension, hyperkalemia, hepatotoxicity, neutropenia, agranulocytosis, pancreatitis, SJS. Contra: pregnancy. Nursing: empty stomach, monitor for infection, dry cough, use contraception (teratogenic), avoid sports drinks/salt substitutes (extra K) ARB drugs -sartan Losartan Valsartan HTN drug of choice for diabetics Ace inhibitors or ARBS these protect kidneys Do not use Ace drugs and _____ together Do not use Ace drugs (lisinopril) and Arb drugs (losartan) together Beta bocker -olol Avoid abrupt discontinuation: wean slowly to avoid rebound HTN Calcium channel blocker "CA" Calan, Procardia, Cardizem Slow the HR and decrease BP (check HR and BP before). Inhibits mvmt of Calcium ions across membrane or cardiac and arterial muscle cells. Results in slowed impulse conduction, depression of myocardial constractility, dilation of coroanry arteries. SE: Constipation Procardia sometimes causes peripheral edema First line treatment of HTN for african americans CCB or Thiazide CCB: cardizem, diltiazem New York Heart Association (NYHA) Function Capacity: Heart failure classification Class II: ordinary activity results in fatigue and dyspnea *Symptoms 1st appear* Left sided heart failure effects ? Lungs S3, crackles, decreased breath sounds, wheezing Right sided heart failure effects? Edema JVD (jugular vein distention) Dyspnea on exertion BMI (body mass index) Underweight - Less than 18.5 Normal - 18.5 - 24.9 Overweight - 25 - 29.9 Obese - 30 - 39.9 Hypercholesterolemia excessive cholesterol in the blood statin first line