NSG 6005 Week 7 Quiz

NSG 6005 Week 7 Quiz Week 7 Quiz Chapters: 16, 20, 34, 47, 25, 38 CVS and Renal Treatments for Heart Failure Stage A: ACEIs are drug of choice; ARBs are considered but more expensive Stage B: ...

NSG 6005 Week 7 Quiz Week 7 Quiz Chapters: 16, 20, 34, 47, 25, 38 CVS and Renal Treatments for Heart Failure Stage A: ACEIs are drug of choice; ARBs are considered but more expensive Stage B: ACEI in all patients, ARB for those who cannot tolerate an ACEI, BBs in most Stage C: ACEI and BBs (nonselective) in all patients, Diuretics, digoxin, Spironolactone Stage D: Stage C treatment, Inotropes: dobutamine, Ventricular assist device, transplantation, hospice ACEIs- Can lower vascular resistance without decreasing cardiac output or glomerular filtration rate -Strong evidence for CV and cerebrovascular risk reduction, HF, and slowing renal disease -Improves oxygenation to heart muscle, decreases innapropriate remodeling of heart muscle after MI or with heart failure, reduces affects of diabetes on the kidneys -Improves insulin sensitivity, does not affect glucose metabolism or raise serum lipid levels -Use with young causcasian patients, patients w/ angina, diabetic patients (prevents or slows nephropathy), HF patients -African American and Asians have 4 to 4 times greater risk of developing angioedema Common ACE inhibitors: Benanzopril Captopril Enalapril Fosinopril Lisinopril Moexipril Angiotensin II Receptor Blockers -Prevent binding of AT II to receptors in kidney, brain, heart, and arterial walls -Inhibit the renin-angiotensin-aldosterone system and cause fall in peripheral resistance -Evidence supports use in kidney disease until late stage and heart failure, but not renal protective like ACEI -No bradykinin-mediated cough like ACEI -Cost of generic ACE inhibitors provides significant advantage over branded ARBs (generics now available for some) -Considered alternatives for patients who cannot tolerate ACE or become resistant -Many combined with hydrochlorothiazide Pharmacokinetics of above: -Losartan CYP 2C9 -Extensive first-pass metabolism resulting in 33% bioavailability -Inducers: rifampin, barbituates -Inhibitors: lovastatin, SMZ/TMP, fluconazolw, fluvastatin, fluvoxamine, sertraline Drug therapies for Dyslipidemia: -HMG CoA reductase inhibitors -Lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin Fibrates: fibric acid derivatives -Gemfibrozil, micronized fenofibrate, clofibrate Bile acid sequestrants -Cholestyramine, colestipol, colesevelam Niacin (has lost its luster) Ezetimibe (Zetia): most effective in combination with statin -Active liver disease is a contraindication for all except the bile acid sequestrants GI GERD and PUD UTI Inflammatory Processes Hormone and Osteoporosis A woman who has migraine with aura: Should not be prescribed estrogen due to an increased risk of stroke occurring with estrogen use Inadequate vitamin D intake can contribute to the development of osteoporosis by: Altering calcium metabolism Infants with congential hypothyroidism are treated with: Levothyroxine Selective estrogen receptor modifiers (SERMs) treat osteoporosis: Selectively acting on the estrogen receptors in the bone Bisphosphonates treat or prevent osteoporosis by: Inhibiting osteoclastic activity Shana is receiving her firse medroxyprogesterone (Depo Provera) injection Hypertension Dosage changes of conjugated equine estrogen (Premarin) are made at ____ intervals. Six to eight weeks Angela is a black woman who has heard that women of African descent do not need to worry about osteoporosis. What education would you provide Angela about her risk? Black women are at risk of developing osteoporosis due to their lower calcium intake as a group A twenty-two-year-old woman receives a prescription for oral contraceptive Counseling regarding decreasing or not smoking while taking oral contraceptives Men who are prescribed sildenafil (Viagra) need ongoing monitoring for: The development of chest pain or dizziness Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs? Glucocorticoids The drug recommended as primary prevention of osteoporosis in women over seventy years old is: Alendronate (Fosamax) Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for: Tachycardia and angina The ongoing monitoring of patients over the age sixty-five years taking alendronate (Fosamax) or any other bisphosphonate is: Annual renal function evaluation When starting a patient with hypothyroidism on thyroid replacement hormones, patient education would include the following: It may take four to eight weeks to get to euthyroid symptomatically and by lab testing A woman who is pregnant and has hyperthyroidism is best managed by a specialty team that will most likely treat her with: Propylthiouracil Absolute contraindications to estrogen therapy include: Clotting disorders The drug recommended as primary prevention of osteoporosis in men over seventy years is: Alendronate (Fosamax) Sallie has been diagnosed with osteoporosis and is asking about the once-a-month pill to treat her condition. How do bisphosphonates treat osteoporosis? -By reducing bone resorption and inhibiting osteoclastic activity Shana is receiving her first medroxyprogesterone (Depo Provera) injection. Shana will need to be monitored for: Depression Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs? Glucocorticoids The ongoing monitoring of patients over the age sixty-five years taking alendronate (Fosamax) or any other bisphosphonate is: Annual renal function evaluation Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing it with their provider or a pharmacist first? Patients with kidney stones Patients who are on chronic long-term PPI therapy require monitoring for Iron deficiency, b12, and calcium deficiency Sadie is a 72 yr old who takes omeprazole for chronic GERD. chronic long term omeprazole use places her at risk for Osteoporosis Metoclopramide improves GERD symptoms by: Increasing lower esophageal tone Laxatives consist of six classes: Stimulants- cascara, senna, bizacodyl, and castor oil Osmotics- magnesium hydroxide, magnesium citrate, sodium phosphate, polyethylene glycol electrolyte solution, and polyethylene glycol (PEG) 3350 Bulk-producing laxatives- psyllium, methylcellulose, and polycarbophil Lubricants- mineral oil Surfactants- docusate compounds: docusate sodium, docusate calcium, and docusate potassium Hyperosmolar laxatives- glycerine and lactulose