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PNN Practice Questions And Answers Test
Bank
When reading a TB skin test, how many mm of induration is considered a positive reading for a pt w/ HIV?
A. >/= 3 mm B. >/= 5 mm C. >/= 10 mm D. >/= 15 mm - B. >/= 5 mm
Induration >/= 5 mm is considered positive in pts w/ low immunity (HIV, on steroid tx) or at high risk for TB infection (close contact w/ someone w/ active TB).
Induration >/= 10 mm is considered positive in healthcare workers, pts w/ DM, and CKD.
Induration >/= 15 mm is considered positive for anyone.
Which BP meds should be used in the general population?
A. ACE-I/ARB B. BB C. CCB D. Thiazides - A. ACE-I/ARB C. CCB D. Thiazides
Which BP meds should be used in DM w/ signs of renal damage?
A. ACE-I/ARB
B. BB
C. CCB
D. Thiazides - A. ACE-I/ARB
Which BP meds should be used for MI or CAD?
A. ACE-I/ARB B. BB C. CCB D. Thiazides - A. ACE-I/ARB B. BB
Which BP meds should be used for CHF?
A. ACE-I/ARB
B. BB
C. CCB
D. Thiazides E. Entresto - Low dose BB (carvedilol, metoprolol, bisoprolol) plus ACE-I/ARB or Entresto.
Which BP meds are safe to use in pregnancy? - 1. Labetalol PO or IV (first line).
- Other BBs (second line).
- Nifedipine ER (Procardia XL) or nicardipine
- Methyldopa
- Hydralazine
Other CCBs and HCTZ are safe to use as well.
Which BP meds are used to treat Raynaud's? - DHP-CCBs (-pines)
Which BP meds should be used in CKD?
A. ACE-I/ARB B. BBs C. CCBs D. Thiazides E. Loops - A. ACE-I/ARB to preserve kidney function
Which BP med is best for pts with ESRD?
A. ACE-I/ARB B. BBs C. CCBs D. Thiazides E. Loops - E. Loops Others can be used as well though.
Caution with ACE-I/ARBs due to hyperkalemia.
Which BP med should be avoided in asthma/COPD?
A. ACE-I/ARB B. BB C. CCB D. Thiazides - B. BB
If a BB must be used, use one that is Beta-1 selective. AMEBBBA: Atenolol (Tenormin), metoprolol (Lopressor, Toprol XL), esmolol (Brevibloc), bisoprolol (Zebeta), betaxolol (Kerlone, Betoptic-S), Bystolic (nebivolol), acebutolol (Sectral).
Which BP med should be avoided in pheochromocytoma hypertensive crisis?
A. ACE-I/ARB B. BB C. CCB D. Thiazides E. Loops - B. BBs should be avoided
How do thiazide diuretics affect:
- Na+
- Cl-
- K+
- Mg2+
- Ca2+
- Glucose
- Cholesterol/Lipids
- Uric Acid - 1. Dec Na+ (Inc lithium)
- Dec Cl-
- Dec K+ (inc digoxin toxicity)
- Dec Mg2+
- Inc Ca2+
- Inc Glucose
- Inc Cholesterol/Lipids
- Inc Uric Acid
How do loop diuretics affect:
- Na+
- Cl-
- K+
- Mg2+
- Ca2+
- Glucose
- Cholesterol/Lipids
- Uric Acid - 1. Dec Na+ (Inc lithium)
- Dec Cl-
- Dec K+ (inc digoxin toxicity)
- Dec Mg2+
- Dec Ca2+
- Inc Glucose
- Inc Cholesterol/Lipids
- Inc Uric Acid
What should be avoided with K+ sparing diuretics? - ACE-Is, ARBs, salt substitutes, patients with ESRD. All increase risk of hyperkalemia.
What are the CIs and cautions of BBs? - CIs: Heart block, bradycardia, asthma/COPD, Raynaud's, cocaine overdose (treat with alpha blockers).
Caution: DM (masks hypoglycemia sx), CHF (use low dose only).
Which BBs are available via IV? - MAPLES (Metoprolol, atenolol, propranolol, labetalol, esmolol, sotalol)
Which BP meds are CI in pregnancy? - ACE-I, ARB, DRIs
Which BB is not used for HTN, but is used for HTN emergency? - Esmolol due to short half- life.
What are the CIs of CCBs? - CHF/HFrEF, heart block, bradycardia. These are due to negative inotropic effects.
Which CCBs affect mostly the arterial blood vessels? - DHP-CCBs (-pines) They have minimal affect on the heart and are therefore safer.
Which CCBs affect the heart? - Non-DHP CCBs
Verapamil affects the heart the most (strong negative chronotrope & inotrope).
Diltiazem affects both the heart and the arteries (vasodilator).
Which CCBs are available in ER tabs? - Felodipine (Plendil), nisoldipine (Sular), and nifedipine (Procardia, Adalat, Afeditab, Nifediac, Nifedical).
ACE-Is/ARBs should be d/c if SCr ____________ or CrCl ___________. - D/c if SCr > 2.5 mg/dL or CrCl < 30 mL/min.
Which med is the only ACE-I available via IV? - enalapril (Enalaprilat, Vasotec)
How is captopril taken? - PO TID on an empty stomach.
Captopril is the only ACE-I taken TID.
Do ACE-Is have inotropic or chronotropic effects on the heart? - No. Therefore they are safe to use in patients with bradycardia or heart block.
What is the AHA/ACC BP goal for the general population? - BP < 130/
What is the AHA/ACC BP goal for CAD/CHF? - BP < 130/
What is the AHA/ACC BP goal for CKD? - BP < 130/
A. Glomeruli B. PCT C. Thin descending limb of the LOH D. Thin ascending limb of the LOH E. Thick ascending limb of the LOH F. Proximal part of the DCT G. DCT H. Distal DCT I. Collecting ducts - F. Proximal DCT
What part of the kidney do thiazide-like diuretics work on?
A. Glomeruli B. PCT C. Thin descending limb of the LOH D. Thin ascending limb of the LOH E. Thick ascending limb of the LOH F. Proximal part of the DCT G. DCT H. Distal DCT I. Collecting ducts - F. Proximal DCT
What part of the kidney do K+ sparing diuretics work on?
A. Glomeruli B. PCT C. Thin descending limb of the LOH D. Thin ascending limb of the LOH E. Thick ascending limb of the LOH F. Proximal part of the DCT G. DCT H. Distal DCT I. Collecting ducts - Both H. and I. Distal DCT and Collecting ducts
What part of the kidney do carbonic anhydrase inhibitors (ex. acetazolamide (Diamox) ) work on?
A. Glomeruli B. PCT C. Thin descending limb of the LOH D. Thin ascending limb of the LOH E. Thick ascending limb of the LOH F. Proximal part of the DCT G. DCT H. Distal DCT
I. Collecting ducts - B. PCT
How many mg of furosemide = 1 mg of bumetanide? - 40 mg furosemide = 1 mg bumetanide
Can Toprol XL be cut in half? - Yes
- Coreg 3.125 mg BID = Coreg CR _____ mg QD
- Coreg 6.25 mg BID = Coreg CR _____ mg QD
- Coreg 12.5 mg BID = Coreg CR _____ mg QD
- Coreg 25 mg BID = Coreg CR _____ mg QD - 1. Coreg 3.125 mg BID = Coreg CR 10 mg QD
- Coreg 6.25 mg BID = Coreg CR 20 mg QD
- Coreg 12.5 mg BID = Coreg CR 40 mg QD
- Coreg 25 mg BID = Coreg CR 80 mg QD
Take Coreg with food!
Start at 3.125 mg BID for CHF. Start at 6.25 mg BID for HTN.
Which allergy is CI for clevidipine (Cleviprex)? - CI in soy or egg allery.
Which route of administration is clevidipine (Cleviprex) available in? - IV only. It is a lipid emulsion.
Describe HTN Urgency.
- BP:
- W/ or w/o sx?
- W/ or w/o target organ damage?
- How should HTN Urgency be treated? - HTN Urgency is BP > 180/120, with no sx, and no target organ damage.
Tx: Lower BP gradually over 24 hrs with PO meds (captopril, clonidine, labetalol, or amlodipine). Do not need IV meds and do not need to go to ER.
Fill in the blanks for HTN Emergency.
- BP:
- W/ or w/o sx:
- W/ or w/o target organ damage:
- How should HTN Emergency be treated? - HTN Emergency:
- BP: Significantly elevated
- With sx
- With target organ damage
C. K+ levels D. HR E. Peripheral edema F. Constipation - D. HR, E. Peripheral edema, F. Constipation
What formulations is diltiazem available in? - PO tabs & caps, and IV for rate control
Which of the following are adverse effects of Calan?
A. Edema B. Hyponatremia C. Hypokalemia D. Constipation E. Gingival hyperplasia - A. Edema, D. Constipation, E. Gingival hyperplasia
What formulations is verapamil available in? - PO tabs & caps, and IV
Which of the following are true about short-acting nifedipine?
A. It is a more potent vasodilator than verapamil or diltiazem B. The negative chronotropic and inotropic effect of nifedipine is clinically insignificant C. May cause hyperuricemia D. Can cause unilateral peripheral edema E. Can cause flushing - A, B, E
Which of the following combos are generally NOT used together?
A. Non-DHP CCB + ACE-I B. ACE-I + ARB C. BB + Non-DHP CCB D. Thiazide diuretic + ACE-I - B. ACE-I + ARB due to increased risk of hyperkalemia. C. BB + Non-DHP CCB due to strong negative inotropic and chronotropic effects on the heart.
Which of the following should be given on an empty stomach?
A. Nisoldipine (Sular) B. Metoprolol tartrate (Lopressor) C. Carvedilol (Coreg) D. Captopril (Capoten) E. Moexipril (Univasc) - A. Nisoldipine (Sular) - Think "I sold it at Soulard so now I have an empty stomach" D. Captopril (Capoten) E. Moexipril (Univasc)
Metoprolol tartrate (Lopressor): Take w/ food.
Metoprolol succinate (Toprol XL): Take w/ or w/o food. Carvedilol (Coreg): Take w/ food! Think "sitting in a CAR wanting fast food"
Which of the following CCBs causes the least HA, flushing, and edema?
A. Verapamil B. Diltiazem C. Nifedipine D. Amlodipine E. Nicardipine - A. Verapamil It is the least potent arterial vasodilator, thus causing less of these adverse effects. However, it has strong negative inotropic and chronotropic effects on the myocardium.
While diltiazem is a potent coronary vasodilator, it also has mild arterial vasodilator effects, thus causing the listed AEs.
"Verapamil is Very specific to the heart" --> Strongly affects the myocardium.
Diltiazem "di = 2 --> affects both the heart and vessels"
DHP-CCBs: -pines = "p stands for periphery" --> affects periphery/vessels --> DOC for Raynaud's and Prinzmetal's angina; little to no inotropic or chronotropic effect.
Which of the following is a problem when using short-acting nifedipine?
A. Reflex bradycardia B. Reflex tachycardia C. Seizures D. Reflex HTN E. Renal impairment - B. Reflex tachycardia Use nifedipine in combination with a BB to prevent this
Which of the following statements are true?
A. Verapamil may cause bradycardia B. Nifedipine may cause mild tachycardia C. Nicardipine can be used in pts with vasospastic angina (Printzmetal's) D. Verapamil is effective in preventing angina attacks and in prolonging exercise duration E. All of the above F. None of the above - E. All of the above
Which of the following alpha-adrenergic antagonists do NOT need to be titrated?
A. Alfuzosin B. Doxazosin C. Silodosin
Which AEs will right-sided HF cause?
A. Peripheral and pitting edema, JVD, ascites, hepatomegaly B. Pulmonary edema, SOB, orthopnea, EF < 40% - A. Peripheral and pitting edema
Think "Left = lungs", therefore right = peripheral
Which AEs will left-sided HF cause?
A. Peripheral and pitting edema, JVD, ascites, hepatomegaly B. Pulmonary edema, SOB, orthopnea, EF < 40% - B. Pulmonary edema and SOB Give loop diuretics such as Lasix to get the fluid out. Standing up/being in a vertical position will help relieve SOB due to gravity pulling fluid down to the base of the lungs.
In which of the following circumstances would you recommend Digifab?
I. Digoxin serum level of 1.0 ng/mL II. An asymptomatic pt with w/ digoxin serum level of 3.2 ng/mL III. A pt w/ worsening bradycardia and digoxin serum level of 3.8 ng/mL
A. I only B. II only C. III only D. II and III E. I, II, and III - C. III only
Digifab is indicated for:
- Hemodynamic instability due to digoxin-induced arrhythmia, esp. bradyarrhythmia.
- Altered mental status due to digoxin toxicity.
- High digoxin level accompanied by hyperkalemia w/ K+ > 5 mEq/L.
- Serum digoxin level > 10 ng/mL
- Ingestion of digoxin > 10 mg in adults.
All of the following are used to treat systolic HF (HFrEF) exacerbation episodes except:
A. IV nitroglycerin B. Furosemide C. Verapamil D. Milrinone - C. Verapamil because it is CI in systolic HF due to being a negative inotrope. Can only use CCBs in diastolic HF (right-sided HFpEF > 40%).
Which of the following can cause digoxin toxicity?
A. Hypokalemia B. Hyperkalemia
C. Hypomagnesemia D. Hypermagnesemia E. Hypocalcemia F. Hypercalcemia - A. Hypokalemia, C. Hypomagnesemia, and F. Hypercalcemia can cause digoxin toxicity.
However, after a pt develops digoxin toxicity sx, K+ and Mg++ levels may increase, thus causing hyperkalemia and hypermagnesemia.
A 69 yo AA pt w/ HF has an elevated BNP and an EF of 32%. Vital signs are stable. Which of the following can you recommend?
A. BiDil B. Toprol XL C. Vasotec D. Calan - A. Isosorbide dinitrate/hydralazine (BiDil), B. Metoprolol succinate (Toprol XL), and C. Enalapril (Vasotec)
Not verapamil (Calan) because Non-DHP CCBs or any other negative inotropic agents should NOT be given to pts with HFrEF (systolic HF).
Which meds may worsen pulmonary edema and leg edema symptoms?
A. Metformin B. Pioglitazone C. HCTZ D. Lisinopril E. Amlodipine - B. Pioglitazone and E. Amlodipine The most common AEs of CCBs are peripheral edema and constipation.
What is the role of digoxin in the tx of pts w/ afib?
A. The positive inotropic effect of digoxin helps afib pts w/ sx B. Digoxin helps cardiovert afib to sinus rhythm C. Digoxin helps w/ controlling ventricular rate D. Digoxin helps w/ controlling atrial rate E. Digoxin helps w/ stroke prevention in pts w/ afib - C. Digoxin helps w/ controlling ventricular rate
Which of the following are true about afib?
A. Thromboembolism is the most important adverse outcome of afib B. Afib can cause pulmonary emboli C. Females w/ afib have a higher rate of ischemic stroke than males D. Afib pts that have had onset of sx > 48 hrs must have an ECHO before cardioversion is attempted - A, C, D
C. Hypoglycemia and/or masking s/sx of hypoglycemia D. Masking signs of hypothyroidism E. Masking signs of Raynaud's dx - A. Hypotension, B. Bronchospasm, C. Hypoglyemia/masking
BBs mask signs of hyperthyroidism (tachycardia), not hypo.
BBs do NOT mask Raynaud's sx. BBs actually worsen/aggravate Raynaud's.
A 78 yo female pt has a CrCl of 10 and a hx of afib. Which of the following anticoagulants would be the most appropriate for her?
A. Warfarin B. Xarelto C. Eliquis D. Pradaxa E. Savaysa - A. Warfarin is preferred in pts w/ ESRD, esp. w/ low CrCl. No renal adjustment necessary.
Eliquis is the 2nd best choise. Normal dose 5 mg PO BID. Adjust dose to 2.5 mg PO BID if 2 or more of the following: Age >/= 80, SCr >/= 1.5 mg/dL, or wt </= 60 kg.
Which of the following conditions are CIs for the use of disopyramide?
A. Myasthenia gravis B. Parkinson's C. Urinary retention D. Glaucoma E. CHF - A. Myasthenia gravis, C. Urinary retention, D. Glaucoma, and E. CHF.
Disopyramide is an anticholinergic which can worsen A, C, and D.
Disopyramide is also a negative inotrope which is CI in HF.
A pt w/ afib is on PO quinidine. She is admitted for symptomatic palpitations and was subsequently diagnosed w/ torsades de pointes. Which of the following meds would you recommend for the tx of her acute condition?
A. Procainamide B. Quinidine C. Insulin + Glucose D. Magnesium sulfate E. Calcium carbonate - D. Magnesium sulfate It treats QT prolongation/torsades.
How does disopyramide increase the ventricular rate in pts w/ uncontrolled afib/aflutter?
A. By blocking AV nodal conduction B. By enhancing AV nodal conduction C. By blocking SA nodal conduction D. By enhancing SA nodal conduction - B. By enhancing AV nodal conduction. This is due to disopyramide's anticholinergic effect.
Procainamide is an effective anti-arrhythmic agent. Its use is limited by which of the following AEs?
A. Lupus-like syndrome B. GI disturbances C. Agranulocytosis D. Pro-arrhythmic properties E. All of the above - E. All of the above
Procainamide is a class Ia Na+ channel blocker available IV and IM. Indicated for ventricular arrhythmias.
AEs: ANA+/lupus-like syndrome, hypotension, bradycardia, GI effects (N/V/major diarrhea), agranulocytosis (dec. WBCs --> infection), torsades.
Vaughan Williams Classification: Class I: Na+ Channel Blockers Ia: DQP --> "Double Quarter Pounder" --> disopyramide, quinidine, procainamide. Ib: PLM --> "Pickles, Lettuce, Mayo" --> phenytoin, lidocaine IV, mexiletine PO Ic: FP "Fries Please" --> flecainide, propafenone
Class II: BB --> Used for rate control in afib IV Acute Tx: MAPLE Metoprolol, atenolol, propranolol, labetalol, esmolol (shortest duration of action) Preferred: Metoprolol, propranolol, esmolol
PO Long-term Rate Control: Use BBs approved for HF --> "the Cardinal Met the Bishop" --> carvedilol, metoprolol succinate, bisoprolol
Antidote to BBs is glucagon.
Class III: K+ Channel Blockers IASDD --> "I Ate Some Delicious Donuts" --> ibutilide, amiodarone, sotalol, dofetilide, dronedarone (Multaq)
Class IV: Non-DHP CCBs --> verapamil and diltiazem
Flecainide is an agent effective against both ventricular and supraventricular arrhythmias. However, its use is limited by its toxicity. Which of the following are true about flecainide?
It takes 4-5 half lives. For pts w/ normal renal function, that is around 6-7 days. It takes longer for pts w/ impaired renal function.
A pt is diagnosed w/ HIT type 2. Which of the following statements are true?
A. Heparin can be re-introduced after 6 months B. Heparin should be avoided for life C. Fondaparinux should be avoided for life D. Enoxaparin should be avoided for life E. This should be considered a heparin allergy on the pt's chart - B, D, E
Which of the following are indications for the use of dabigatran (Pradaxa)?
A. Reduction in the rate of stroke in non-valvular afib B. Tx of DVT and PE after 5-10 days of parenteral anticoagulation C. Reduction in the risk of DVT/PE recurrence in previously treated pts D. STEMI E. Stroke - A, B, C
What is the MOA of Pradaxa?
A. Direct factor Xa inhibitor B. Indirect factor Xa inhibitor C. Direct factor IXa inhibitor D. Direct factor IIa inhibitor - D. Direct factor IIa inhibitor
Which drug is the only PO direct thrombin inhibitor?
A. Argatroban B. Bivalrudin (Angiomax) C. Desirudin (Iprivask) D. Dabigatran (Pradaxa) - D. Dabigatran (Pradaxa)
A 59 yo female pt w/ a wt of 82 kg and Ht of 5'5" has a PMH of HIT 3 yrs ago from heparin exposure. This morning she was admitted to the hospital w/ a new DVT. Which med should you recommend?
A. Fragmin 5 mg SQ daily B. Arixtra 7.5 mg SQ daily C. Tinzaparin 10 mg SQ daily D. Lovenox 60 mg SQ q E. Lovenox 90 mg SQ q12 - B. Arixtra 7.5 mg SQ daily Fondaparinux is a direct factor Xa inhibitor and is safe to use in pts w/ HIT.
Pts w/ a hx of HIT should NEVER receive any type of heparin for life. Thus, meds such as dalteparin (Fragmin), enoxaparin (Lovenox), or tinzaparin (Innohep) should not be recommended.
Which of the following are true about fondaparinux?
A. It can be used for DVT tx B. It can be used for DVT px C. When administered for DVT px, the dose is based on the pt's wt D. When administered for DVT tx, the dose is based on the pt's wt E. It may cause thrombocytopenia, but lacks cross-reactivity w/ HIT antibodies F. It can be given to pts w/ a hx of HIT - A, B, D, E, F
Px dose is 2.5 mg SQ daily Tx dose if wt < 50 kg: 5 mg SQ daily wt 50-100 kg: 7.5 mg SQ daily wt > 100 kg: 10 mg SQ daily
Which of the following are beneficial for intermittent claudication?
A. Warfarin B. Cilostazol C. Aspirin D. Vit. E supplementation E. Gingko biloba - B. Cilostazol and C. Aspirin
What is the dose of Lovenox for DVT px for knee replacement surgery?
A. 1 mg/kg SQ daily B. 1 mg/kg IM daily C. 1.5 mg/kg SQ q D. 30 mg SQ daily E. 30 mg SQ q F. 40 mg SQ daily G. 40 mg SQ q12 - E. 30 mg SQ q
What is the dose of Lovenox for DVT px for abdominal surgery?
A. 1 mg/kg SQ daily B. 1 mg/kg IM q C. 1.5 mg/kg SQ q D. 30 mg SQ daily E. 30 mg SQ q F. 40 mg SQ daily G. 40 mg SQ q12 - F. 40 mg SQ daily
