Pharmacotherapy - Hypertension And Heart Failure

Front 1

Diuretics examples

Back 1

Hydrochlorothiazide or Furosemide

Front 2

Diuretics mechanism

Back 2

Reduce CO and TPR (increases fluid excretion by kidneys)

Front 3

Beta Blockers examples

Back 3

Metoprolol or Atenolol

Front 4

Beta Blockers mechanism

Back 4

Reduce CO (block beta-1 receptors on heart)

Front 5

Calcium Channel Blockers examples

Back 5

Diltiazem, Verapamil SR, or Amlodipine

Front 6

Calcium Channel Blockers mechanism

Back 6

Reduce CO and TPR (dilate arterioles)

Front 7

ACE-Inhibitors examples

Back 7

Enalapril or Lisinopril

Front 8

ACE-Inhibitors mechanism

Back 8

Reduce TPR (Inhibit angiotensin-converting enzyme which prevents formation of the vasoconstrictor angiotensin II)

Front 9

Angiotensin Receptor Blockers examples

Back 9

Losartan or Valsartan

Front 10

Angiotensin Receptor Blockers mechanism

Back 10

Reduce TPR (Blocks vasoconstrictor angiotensin II from binding to arteriole receptors)

Front 11

NYHA Functional Class I

Back 11

Asymptomatic during normal activity

Front 12

NYHA Functional Class II

Back 12

Mild symptoms during normal activity

Front 13

NYHA Functional Class III

Back 13

Symptoms noted with minimal activity

Front 14

NYHA Functional Class IV

Back 14

Symptoms at rest

Front 15

AHA/ACC Functional Stage A

Back 15

At risk for structural heart disease due to risk factors

Front 16

AHA/ACC Functional Stage B

Back 16

Asymptomatic but demonstrate structural heart disease (left ventricular hypertrophy)

Front 17

AHA/ACC Functional Stage C

Back 17

Past or current symptoms of HF associated with underlying structural disease

Front 18

AHA/ACC Functional Stage D

Back 18

Refractory HF/end-stage disease

Front 19

Normal blood pressure

Back 19

Under 120/80 mmHg

Front 20

Prehypertension

Back 20

120-139/80-89 mmHg

Front 21

Stage 1 Hypertension

Back 21

140-159/90-99 mmHg

Front 22

Stage 2 Hypertension

Back 22

Over 160/100 mmHg

Front 23

Which of the following is a medication used to treat chronic stable angina?
a. Angiotensin receptor blockers
b. Diuretics
c. Glitazones
d. Nitrates

Back 23

d. Nitrates

Front 24

________________ is the most common and significant consequence of hyperlipidemia.
a. Premature Atherosclerosis
b. Diabetes mellitus
c. Kidney failure
d. Retinopathy

Back 24

a. Premature Atherosclerosis

Front 25

__________ cholesterol is the primary target for treatment according to the ATP III guidelines.
a. Total
b. HDL
c. LDL
d. Triglycerides
e. VLDL

Back 25

c. LDL

Front 26

Following lifestyle modifications, patients with a high LDL-cholesterol should be initiated on which class of medications?
a. Niacin
b. Statin
c. Nitrate
d. Bile acid sequestrant

Back 26

b. Statin

Front 27

Which of the following is a modifiable risk factor for coronary heart disease (CHD)?
a. Family history of premature CHD
b. Current cigarette smoking
c. Advanced age
d. History of stroke

Back 27

b. Current cigarette smoking

Front 28

When counseling a patient on the use of a short-acting nitrate for the relief of angina, (s)he should be instructed to dial 911 after taking how many nitroglycerin tablets without relief?
a. 1
b. 2
c. 3
d. 4
e. 5

Back 28

c. 3

Front 29

All patients with known CHD should be receiving which of the following type or class of medication unless contraindicated?
a. Calcium channel blocker
b. Anti-platelet agent
c. Bile acid sequestrant
d. Fibric acid derivative

Back 29

b. Anti-platelet agent

Front 30

According to the ACC/AHA guidelines for the treatment of heart failure
a. Stage B is to be treated with an ACE-Inhibitor, beta-blocker, and digoxin
b. Stage A is to be treated primarily with lifestyle modifications
c. Stage D is to be treated with a mechanical device, heart transplant, and hospice care
d. All stages of heart failure should include digoxin

Back 30

b. Stage A is to be treated primarily with lifestyle modifications

Front 31

What percentage of patients with hypertension are adequately controlled?
a. 75%
b. 50%
c. 30%
d. 5%

Back 31

c. 30%

Front 32

In general, the pharmacological treatment of hypertension should begin with or include which of the following classes of drugs:
a. Thiazide diuretic
b. ACE-Inhibitor
c. Calcium Channel Blocker
d. Loop diuretic

Back 32

a. Thiazide diuretic

Front 33

The community pharmacist’s role in the management of hypertension and heart failure consists of
a. the identification of signs and symptoms of heart failure
b. the encouragement for patients to take charge of their disease states
c. the counseling on dietary and life style changes and OTC choices
d. all of the above

Back 33

d. all of the above

Front 34

Non-pharmacological approaches to hypertension and heart failure management include all of the following EXCEPT
a. limiting alcoholic beverages
b. smoking cessation
c. weight control
d. limiting exercise

Back 34

d. limiting exercise

Front 35

The Renin Angiotensin System (RAS)
a. plays a role in hypertension alone
b. plays a role in heart failure alone
c. has no effect on cardiac remodeling
d. consists of both ACE and non-ACE dependent pathways

Back 35

d. consists of both ACE and non-ACE dependent pathways

Front 36

Which of the following is most likely to be used in the management of both heart failure and stable angina?
a. β blocker
b. diuretic
c. anti-platelet
d. statin

Back 36

a. β blocker

Front 37

Which of the following is LEAST likely to occur when sublingual nitroglycerin is used?
a. hypotension
b. headache
c. dizziness
d. sore throat
e. all of the following are adverse reactions of nitroglycerin

Back 37

d. sore throat

Front 38

Which of the following is LEAST likely to be used to treat hypertension and heart failure?
a. β blocker
b. diuretic
c. angiotensin converting enzyme inhibitor
d. bile acid sequestrant

Back 38

d. bile acid sequestrant

Front 39

Into which category does a patient with a blood pressure of 137/82 fall?
a. Normal
b. Prehypertension
c. Stage I hypertension
d. Class B hypertension

Back 39

b. Prehypertension

Front 40

According to the Adult Treatment Panel III, all of the following are major risk factors that modify LDL goals EXCEPT:
a. Family history of premature coronary heart disease
b. Obesity
c. Age
d. Low HDL

Back 40

b. Obesity

Front 41

The following lipoprotein is considered to be “protective” and can potentially count as a negative risk factor for development of cardiovascular disease:
a. Low-density lipoprotein (LDL)
b. Intermediate density lipoprotein (IDL)
c. High density lipoprotein (HDL)
d. Very-low-density lipoprotein (VLDL)

Back 41

c. High density lipoprotein (HDL)

Front 42

Though not in the Adult Treatment Panel III (ATP III) guidelines, which of the following most correctly describes the new recommended LDL goal for “Very High Risk” patients?
a. LDL < 60 mg/dL
b. LDL < 70 mg/dL
c. LDL < 80 mg/dL
d. LDL < 90 mg/dL

Back 42

b. LDL < 70 mg/dL

Front 43

All of the following are pharmacologic drug classes that are used to treat
hyperlipidemia EXCEPT:
a. HMG CoA Reductase Inhibitors
b. Bile Acid Resins
c. ACE-Inhibitors
d. Fibric Acids

Back 43

c. ACE-Inhibitors

Front 44

All of the following are Over The Counter (OTC) products for treating
hyperlipidemia EXCEPT:
a. Niacin
b. Vitamin A
c. Flaxseed oil
d. Fish oil supplements

Back 44

b. Vitamin A

Front 45

All of the following are drug classes that are used to manage chronic, stable angina EXCEPT:
a. Nitrates
b. B-blockers
c. Antiplatelets
d. Diuretics

Back 45

d. Diuretics

Front 46

What is the maximum number of times/doses a patient can dissolve or spray nitroglycerin when experiencing an anginal attack?
a. Five
b. Three
c. Two
d. There is no maximum

Back 46

d. There is no maximum

Front 47

Antihypertensive therapy is associated with which of the following:
a. Reduction in MI incidence
b. Reduction in stroke incidence
c. Reduction in HF incidence
d. Reduction in DM Type II incidence
e. All of the above
f. a, b, and c only
g. a and b only

Back 47

f. a, b, and c only

Front 48

Target organ damage resulting form hypertension includes which of the following?
a. Heart failure
b. Stroke
c. Chronic kidney disease
d. Retinopathy
e. All of the above
f. None of the above

Back 48

e. All of the above

Front 49

When should antihypertensive drug therapy be initiated (SBP = systolic blood pressure; DBP = diastolic blood pressure)?
a. SBP<120 and DBP<80
b. SBP 140-159 or DBP 90-99
c. SBP 120-139 or DBP 80-89 without compelling indications
d. SBP 120-139 or DBP 80-89 with compelling indications
e. b and c only
f. b and d only
g. b, c, and d

Back 49

f. b and d only

Front 50

Lifestyle modifications in patients with hypertension include which of the following?
a. Weight reduction
b. Physical activity
c. Moderation of alcohol intake
d. All of the above
e. a and b only

Back 50

d. All of the above

Front 51

The main reason why heart failure (HF) is commonly called “Congestive heart failure” is because the disease is associated with which of the following?
a. Fatigue
b. Fluid overload
c. Shortness of breath
d. Limited exercise tolerance

Back 51

b. Fluid overload

Front 52

A patient with heart failure who experiences symptoms with less-than-ordinary exertion is most appropriately placed in which of the following functional classes?
a. Class I
b. Class II
c. Class III
d. Class IV

Back 52

c. Class III

Front 53

Which of the following class(es) of drugs is/are included in the algorithms for management of both hypertension and heart failure?
a. calcium channel blockers
b. beta blockers
c. diuretics
d. ACE inhibitors
e. All of the above appear in both algorithms
f. b,c, and d only
g. c and d only

Back 53

f. b,c, and d only

Front 54

AJ is a 64 year old woman who presents to your pharmacist-run hypertension clinic. AJ is not currently on antihypertensive therapy. She has been attempting lifestyle modification for approximately 2 months. AJ's blood pressure is as follows:
1/31: 170/110, repeat 168/108
2/14: 158/108, repeat 166/106
3/12: 160/106, repeat 158/110
What state hypertension does AJ have and what class of antihypertensive drug therapy is a potential treatment for her?
a. Stage III, diuretic
b. Stage III, long-acting nitrate
c. Stage II, diuretic
d. Stage III, long-acting nitrate

Back 54

c. Stage II, diuretic

Front 55

When you finish counseling GA on his medications, GA informs you that he will not be picking up his antihypertensive medications at this time because he feels fine. Which of the following is likely to be a good explanation to GA of why his antihypertensive therapy is important?
a. it serves to reduce your risk of coronary heart disease
b. it serves to reduce your risk of long term organ damage
c. it serves to reduce your risk of stroke
d. A, B and C

Back 55

d. A, B and C

Front 56

JJ describes to you that she becomes short of breath while sitting on the couch watching television.
What New York Heart Association functional class would JJ be in, and what are 3 examples of heart
failure signs or symptoms?
a. III; anorexia, headache, pulmonary edema
b. III; paroxysmal nocturnal dyspnea, cough, rales
c. IV; abdominal pain, hepatomegaly, tremor
d. IV; dyspnea on exertion, cough, nausea

Back 56

d. IV; dyspnea on exertion, cough, nausea

Front 57

What has been shown to be first line medication for the treatment of heart failure?
a. Warfarin
b. an Angiotensin receptor blocking agent
c. an alpha adrenergic blocker
d. an ACE inhibitor

Back 57

d. an ACE inhibitor

Front 58

A 47 year old patient well known to you is taking sotalol (Betapace), a class III anti-arrhythmic agent,
for treatment of atrial fibrillation. Which of the following most closely describes the goal of therapy for
this patient with this medication?
a. absence of adverse drug reactions
b. maintenance of therapeutic concentrations
c. maintenance ventricular rate < 90 beats/min
d. conversion of atrial fibrillation to normal sinus rhythm

Back 58

d. conversion of atrial fibrillation to normal sinus rhythm

Front 59

Which of the following correctly characterizes one difference between atrial and ventricular
tachycardia.
a. the origin of the arrhythmia
b. atrial rate with atrial tachycardia is faster than ventricular rate with ventricular tachycardia
c. atrial rate with atrial tachycardia is slower than the ventricular rate with ventricular tachycardia
d. there is no difference between these two arrhythmias.

Back 59

a. the origin of the arrhythmia

Front 60

A 35 year old woman is found to have renal artery thrombus and her physician wishes to treat this
problem aggressively. Use of which of the following will most likely result with immediate dissolution
of this clot?
a. use of a glycoprotein IIb/IIIa inhibitor
b. use of a thrombolytic agent
c. use of unfractionated heparin, an anticoagulant
d. use of warfarin, an anticoagulant

Back 60

b. use of a thrombolytic agent

Front 61

MP is a 52-year old female with hypertension who comes into the clinic for a routine check-up. She smokes 1 pack a day of cigarettes and denies drinking alcohol. The following are the results of her fasting lipid profile:
Total cholesterol 295 mg/dL
LDL 200 mg/dL
HDL 65 mg/dL
Triglyceride 151./dL
According to the ATP III Classification of cholesterol, which of the following is MP’s LDL classification?
a.Optimal
b.Borderline high
c.High
d.Very high

Back 61

d.Very high

Front 62

MP is a 52-year old female with hypertension who comes into the clinic for a routine check-up. She smokes 1 pack a day of cigarettes and denies drinking alcohol. The following are the results of her fasting lipid profile:
Total cholesterol 295 mg/dL
LDL 200 mg/dL
HDL 65 mg/dL
Triglyceride 151./dL
Based on the information given, into which of the following “Risk Category” that modifies LDL goals would MP fall?
a.0 – 1 Risk Factor
b.2+ Risk Factors
c.CHD or CHD Risk Equivalent
d.MP does not fall in any “Risk Category”

Back 62

a.0 – 1 Risk Factor

Front 63

MP is a 52-year old female with hypertension who comes into the clinic for a routine check-up. She smokes 1 pack a day of cigarettes and denies drinking alcohol. The following are the results of her fasting lipid profile:
Total cholesterol 295 mg/dL
LDL 200 mg/dL
HDL 65 mg/dL
Triglyceride 151./dL
Which of the following would be MP’s LDL goal?
a.< 200 mg/dL
b.< 160 mg/dL
c.< 130 mg/dL
d.< 100 mg/dL

Back 63

b.< 160 mg/dL

Front 64

16.Which of the following is most likely to be caused by hyperlipidemia?
a.Hypertension and coronary heart disease
b.Hypertension and diabetes
c.Artherosclerosis and hypothyroidism
d.Artherosclerosis and coronary heart disease

Back 64

d.Artherosclerosis and coronary heart disease

Front 65

TL is a 65-year old male who presented to the hospital emergency department with complaints of chest pains. “I’ve been really stressed out lately because my daughter just moved out to go to college yesterday. Then, this morning, as I was doing yard work, I started feeling a heavy, tight, uncomfortable pressure and squeezing pain in the center of my chest. The pain is accompanied by shortness of breath but was quickly relieved by rest. I’m worried. Help me.”
16.TL has the typical clinical presentation of stable angina pectoris. All of the following best describes the clinical presentation of stable angina pectoris EXCEPT:
a.Chest pain that radiates to the shoulder, arm, or back provoked by vigorous exercise
b.Heavy, uncomfortable pressure in the center of the chest provoked by emotional stress
c.Uncomfortable pressure and squeezing chest pain while at rest
d.Predictable episodes of substernal chest pain often relieved by rest

Back 65

c.Uncomfortable pressure and squeezing chest pain while at rest

Front 66

16.A non-pharmacological treatment of stable angina pectoris is lifestyle modification. According to ACC/AHA guidelines, this includes all the following EXCEPT:
a.30 – 60 minutes of exercise 5 – 7 days per week
b.Eating meals high in whole grains
c.Weight management
d.Sleeping at least 8 hours every night

Back 66

d.Sleeping at least 8 hours every night

Front 67

16.Based on current ACC/AHA guidelines, which of the following initial drug therapy regimen would be the best option to treat TL’s stable angina pectoris?
a.Aspirin only
b.Aspirin, beta blockers, and sublingual nitroglycerin as needed
c.Beta blockers, long acting nitrates, and calcium channel blockers
d.Long acting nitrates only

Back 67

b.Aspirin, beta blockers, and sublingual nitroglycerin as needed

Front 68

22.Which of the following best describes the benefit of using two antihypertensive agents from different classes to treat hypertension?
a.Adding a second blood pressure medication improves the safety and efficacy of the first blood pressure medication.
b.Using two medications is always recommended, even if they are not from different classes.
c.This combination has the benefit of chemically altering two or more chemical systems involved in hypertension, which allows for lower doses and decreases the potential for side effects.
d.A blood pressure agent from another class can increase the compliance rate for patients who are noncompliant with one medication.

Back 68

c.This combination has the benefit of chemically altering two or more chemical systems involved in hypertension, which allows for lower doses and decreases the potential for side effects.

Front 69

22.Which of the following is most likely to cause an increase in blood pressure and exacerbate hypertension?
a.Estrogen-containing medications, thyroid medications, pseudoephedrine
b.Estrogen-containing medications, corticosteroids, pseudoephedrine
c.Erythropoiesis-stimulating agents, ibuprofen, metformin
d.Erythropoiesis-stimulating agents, thyroid medications, metformin

Back 69

b.Estrogen-containing medications, corticosteroids, pseudoephedrine

Front 70

22.A 41 year old patient presents to the clinic with a blood pressure (BP) of 154/87 mmHg. His last BP reading at the clinic was 152/93 mmHg. The patient states that he feels fine and has no medical conditions. What is the best recommendation for this patient?
a.Tell the patient that since he is asymptomatic, he is not at risk for hypertension at this time.
b.Advise the patient that he needs 3 or more blood pressure readings from 3 or more visits to be classified with hypertension.
c.Inform the patient that he has stage I hypertension and that he should initiate lifestyle modifications at this time.
d.Inform the patient that he has stage I hypertension and that he should begin an antihypertensive drug, such as a thiazide diuretic, in addition to beginning lifestyle modifications.

Back 70

d.Inform the patient that he has stage I hypertension and that he should begin an antihypertensive drug, such as a thiazide diuretic, in addition to beginning lifestyle modifications.

Front 71

22.When considering initial therapy of hypertension with two antihypertensives, which of the following is closest to the current JNC-7 recommendation?
a.This can be considered for patients >20/10 mmHg above their goal; preferred therapy includes a thiazide diuretic plus an agent from another class.
b.This can be considered for patients >20/10 mmHg above their goal; preferred therapy includes a calcium channel blocker plus an agent from another class.
c.This can be considered for patients >40/20 mmHg above their goal; preferred therapy includes a thiazide diuretic plus an agent from another class.
d.This can be considered for patients >40/20 mmHg above their goal; preferred therapy includes a calcium channel blocker plus an agent from another class.
e.Starting initial therapy with two antihypertensives is not recommended.

Back 71

a.This can be considered for patients >20/10 mmHg above their goal; preferred therapy includes a thiazide diuretic plus an agent from another class.

Front 72

22.A patient has stage C heart failure and is currently taking an ACE inhibitor, aspirin, nitroglycerin for chest pain, and a calcium channel blocker for hypertension and coronary artery disease. The patient does not report any heart failure symptoms at this time. What would be the best recommendation for this patient?
a.Discontinue the ACE inhibitor and start an ARB since the mortality benefit is greater with an ARB.
b.Add a diuretic if the patient becomes symptomatic.
c.Add a beta-blocker and consider discontinuing the calcium channel blocker since it does not have a place in HF management.
d.Both b and c
e.Both a and b

Back 72

d.Both b and c

Front 73

22.A patient with stage B heart failure and stage II hypertension has to discontinue her ACE inhibitor because she develops a cough as a side effect of treatment. What is the best recommendation for this patient to help reduce further structural damage and remodeling of the heart?
a.Advise the patient to try an angiotensin receptor blocker as an alternative to the ACE inhibitor.
b.Advise the patient to try a diuretic as an alternative to the ACE inhibitor.
c.Advise the patient to try a beta blocker as an alternative to the ACE inhibitor once the patient progresses to stage C heart failure.
d.There is no alternative to an ACE inhibitor for reduction in structural damage and remodeling in stage B heart failure. The patient will have to wait till she develops stage D heart failure when an aldosterone antagonist can be initiated to reduce remodeling.

Back 73

a.Advise the patient to try an angiotensin receptor blocker as an alternative to the ACE inhibitor.

Front 74

22.If a patient has “left-sided” heart failure, what types of signs and symptoms would you most likely expect on a physical exam?
a.Crakles, rales, shortness of breath, orthopnea
b.Crackles, rales, jugular venous distension, ascites
c.S3 gallop, rales, jugular venous distension, ascites
d.Lower extremity edema, jugular venous distension, ascites

Back 74

a.Crakles, rales, shortness of breath, orthopnea