Download Anticoagulation Certificate Program

Cardiology Practice Based Program
June 1-2, 2012
LaGuardia Marriott, East Elmhurst, NY
Home Study
The home study portion is designed to provide a comprehensive foundational knowledge to the participant so that they
can engage in the subsequent didactic and interactive case-based program.
Each section will provide the learner with review questions to assist them with their studies and assess their
understanding of the materials.
After completing these sections, the participant will be required to complete the self-study open book test. The test
must be completed by no later than May 26, 2012 with test answers faxed to NYSCHP at 518-456-9319. The
home study portion must be completed in order to participate in the live program. A passing score of 70% must
be achieved on the self-study online exam. Those failing to achieve this score will be contacted prior to the program for
discussion and remediation.
ACUTE DECOMPENSATED HEART FAILURE
Learning Objectives:
1.
Describe the pathophysiology, epidemiology, and etiology of acute decompensated heart failure (ADHF) and to identify
prognostic factors that can be used to stratify patients with ADHF by risk for unfavorable outcomes.
2.
Recommend a strategy to manage patients with ADHF experiencing refractoriness to intravenous diuretic therapy.
3.
Differentiate the role of therapies for the management of ADHF including the use of vasodilators and inotropes.
Required Readings
Lindenfeld J, Albert NM, Boehmer JP, et al. Evaluation and management of patients with acute decompensated heart
failure: HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail 2010; 16:e134-56.
Coons JC, McGraw M, Murali S. Pharmacotherapy for acute heart failure syndromes. Am J Health Syst Pharm. 2011
Jan 1;68(1):21-35.
Study Guide Materials
1. In the setting of ADHF, describe what physiologic processes are reflected by changed in the following parameters:
pulmonary capillary wedge pressure (PCWP), systemic vascular resistance (SVR), and cardiac output (CO). (Coons et
al, Page 22)
2. Understand the various clinical profiles of ADHF. (Coons et al, Page 23, Table 1)
3. Utilizing the classification scheme for ADHF, differentiate between wet and dry heart failure as well as warm and cold
heart failure. (Coons et al, Page 23, Figure 1)
4. Know the various potential precipitants of ADHF including iatrogenic factors. (Coons et al, Page 24, Table 2)
5. Appreciate the indications for hospitalization of the patient presenting with ADHF and goals for hospitalization. (HFSA
Guidelines, Page e137, Table 12.1 and 12.3)
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6. Review appropriate monitoring parameters for patients hospitalized for ADHF including laboratory evaluation. (HFSA
Guidelines, Page e139, Table 12.4 and 12.5)
7. Describe the various maneuvers that may be used to overcome diuretic resistance. (Coons et al, Page 25 and HFSA
Guidelines, Page e142, 12.11)
8. Differentiate the actions of vasodilator therapies used to manage ADHF. (Coons et al, Page 25-27 or HFSA
Guidelines, Page e144-e145)
9. Differentiate the actions of inotropic therapies used to manage ADHF. (Coons et al, Page 28-29 or HFSA Guidelines,
Page e148)
10. Describe the role of BNP-guided therapy in the management of ADHF. (Coons et al, Page 30-31 or HFSA Guidelines,
e134-e136, 12.1)
CHRONIC HEART FAILURE
Learning Objectives:
1.
Describe the pathophysiology, epidemiology, and etiology or chronic heart failure.
2.
Distinguish current approaches to the routine management of chronic heart failure including the use of diuretics,
angiotensin converting enzyme inhibitors / angiotensin receptor blockers, and beta blockers.
3.
Differentiate the role of adjunct therapies for the management of chronic heart failure including the use of digoxin,
aldosterone antagonists, and combination of hydralazine/isosorbide dinitrate.
Required Readings
Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the
Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American
Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and
Lung Transplantation. J Am Coll Cardiol. 2009; 53:e1-e90.
McMurray JJ. Systolic heart failure. N Engl J Med. 2010; 362:228-38.
Study Guide Materials
1. Understand the pathophysiology of chronic systolic HF. (McMurray et al, Page 229, Figure 1)
2. Comprehend the classification of recommendations and level of evidence used by the ACC/AHA Chronic HF
Guidelines. (ACC/AHA HF Guidelines, Page e4, Table 1)
3. Review the clinical classifications of HF severity including functional class and stages. (McMurray et al, Page 231,
Table 2)
4. Describe recommended drug therapy for chronic heart failure by stage. (ACC/AHA HF Guidelines, Page e9, Figure 1)
5. Know what adjunct therapy to initiate in patients with chronic HF who remain symptomatic despite standard therapy
with ACE inhibitors and beta blockers. (McMurray et al, Page 232, Figure 2 or ACC/AHA HF Guidelines, Page
e21-e22).
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6. Appreciate target doses of commonly prescribed standard chronic systolic HF therapies. (McMurray et al, Page 233,
Table 3 or ACC/AHA HF Guidelines, Page e29, Table 6)
7. Understand absolute and relative contraindications to evidence-based therapies used to treat chronic systolic HF.
(McMurray et al, Page 233, Table 3 or ACC/AHA HF Guidelines, Page e22-e35 and e37-e38)
8. Recognize the roll of device therapy in the management of chronic systolic HF. (McMurray et al, Page 235 or
ACC/AHA HF Guidelines, Page e35-e39)
9. Evaluate and modify drug therapy regimens in patients with heart failure with concomitant disease states including
diabetes, atrial fibrillation, chronic kidney disease, and chronic obstructive pulmonary disease. (ACC/AHA HF
Guidelines, Page e54-e59)
Rate and Rhythm Control in Atrial Fibrillation
Antithrombotic Therapy in Atrial Fibrillation
Learning Objectives
1. Discuss the mechanism of action, clinical indications, and side effect profiles of the class I, II, III, and IV
antiarrhythmic drugs.
2. Describe the pathophysiology, epidemiology, and etiology of atrial fibrillation (AF) and to discuss the various
methods for stratifying a patient’s risk for developing stroke in the presence of AF.
3. Explain the role of rate-control vs. rhythm-control treatment strategies in the management of AF.
Required Readings
You JJ, Singer DE, Howard PA, et al. Antithrombotic therapy for atrial fibrillation: Antithrombotic therapy and
prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
Chest. 2012;141:e531S-e575S.
2011 ACCF/AHA/HRS Focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of
patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association
Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in
collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Available at:
http://content.onlinejacc.org/cgi/reprint/57/11/e101.pdf
2011 ACCF/AHA/HRS Focused update on the management of patients with atrial fibrillation (updating the 2006
guidelines): a report of the American College of Cardiology Foundation/American Heart Association Task Force on
Practice Guidelines. Available at: http://content.onlinejacc.org/cgi/reprint/57/2/223.pdf
2011 ACCF/AHA/HRS Focused update on the management of patients with atrial fibrillation (update on dabigatran): a
report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice
Guidelines. Available at: http://content.onlinejacc.org/cgi/reprint/57/11/1330.pdf
Zimetbaum P. Antiarrhythmic drug therapy for atrial fibrillation. Circulation. 2012;125:381-389.
Goldschlager N, Epstein AE, Naccarelli GV, et al. A practical guide for clinicians who treat patients with amiodarone:
2007. Heart Rhythm. 2007;4:1250-1259.
Study Guide
1. What is the role of reentry in the pathophysiology of atrial fibrillation (AF)?
2. What is the pathophysiologic mechanism for patients with AF developing thromboembolic events, namely ischemic
stroke?’
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3. What are the potential etiologies of AF? What are the most common etiologies of this arrhythmia? How do these
conditions potentially lead to AF development?
4. What hemodynamic consequences can occur in patients with AF?
5. What is/are the differences between paroxysmal AF, persistent AF, recurrent AF, and permanent AF?
6. What is meant by “rate control” and “rhythm control” in the management of AF?
7. What clinical trials have been conducted to compare the efficacy and safety of rate-control and rhythm-control
treatment strategies in patients with AF? In general, what were the overall findings of these clinical trials?
8. Based on the results of the clinical trials mentioned in Question #7, what is the role of rate control vs. rhythm
control in patients with AF? When should a rate-control treatment strategy be used as first-line therapy in patients
with AF? When would it be reasonable to consider a rhythm-control treatment strategy in patients with AF?
9. What drugs can be used to control ventricular rate in patients with AF? Which of these drugs is considered first-line
therapy for ventricular rate control in patients with a normal left ventricular ejection fraction (LVEF) (i.e. >40%)?
Which of these drugs would be appropriate to use in a patient with systolic heart failure (LVEF <40%)?
10. Discuss when electrical vs. pharmacologic conversion strategies would be used to restore sinus rhythm in patients
with AF.
11. What antiarrhythmic drugs can be used to convert patients from AF to sinus rhythm? Which of these drugs are
preferred for cardioversion of AF?
12. What antiarrhythmic drugs can be used to maintain sinus rhythm in patients with AF?
13. Which antiarrhythmic drugs are preferred for maintenance of sinus in patients with the following conditions: a) No
structural heart disease; b) Hypertension with significant left ventricular hypertrophy; c) Coronary artery disease;
and d) Heart failure?
14. What drugs are considered class I (Ia, Ib, Ic), class II, class III, and class IV antiarrhythmics? What is the general
mechanism of action of each of these classes of antiarrhythmic drugs?
15. What types of arrhythmias are each of the following antiarrhythmic drugs indicated for: lidocaine, flecainide,
propafenone, amiodarone, ibutilide, sotalol, dofetilide, and dronedarone?
16. What are the main side effects of the following antiarrhythmic drugs: flecainide, propafenone, amiodarone,
ibutilide, sotalol, dofetilide, and dronedarone?
17. For patients receiving amiodarone for the treatment of AF, how often should they be monitored for the drug’s
various organ toxicities?
18. Which of the class Ic and class III antiarrhythmics need to be dose-adjusted in patients with renal dysfunction?
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19. What are the clinically important drug interactions with the following antiarrhythmic drugs: flecainide, propafenone,
amiodarone, sotalol, dofetilide, and dronedarone? Are these antiarrhythmic drugs substrates, inhibitors, and/or
inducers of the cytochrome P450 enzyme system or P-glycoprotein? If so, which isoenzymes of the cytochrome
P450 system are affected by each drug?
20. What are the differences between the CHADS2 and CHA2DS2-VASc stroke risk stratification methods for patients
with AF? Which of these scoring systems is recommended by the updated American College of Chest Physicians
(ACCP) guidelines for stroke prevention in AF?
21. How are these stroke risk stratification scoring systems used to categorize patients with AF as being at low,
intermediation, or high risk for stroke?
22. According to the updated ACCP guidelines, what antithrombotic therapy is recommended for patients with AF who
are at low-risk, intermediate-risk, or high-risk for stroke?
Acute Coronary Syndromes
Learning Objectives:
1.
Differentiate different types of acute coronary syndrome (ACS).
2.
Define major pharmacotherapeutic recommendations made by the current American Heart
Association/American College of Cardiology in management of different types of ACS.
3.
Describe pharmacologic profile of different antiplatelets and anticoagulants use in managing ACS.
Required Readings:
2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients
With Unstable Angina/Non-ST Elevation Myocardial Infarction: A Report of the American College of Cardiology
Foundation/American Heart association Task Force on Practice Guidelines. Available at:
http://circ.ahajournals.org/content/123/18/e426.full.pdf
2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction
(Updating the 2004 and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American
Heart Association Task Force on Practice Guidelines. Available at:
http://circ.ahajournals.org/content/120/22/2271.full.pdf
2007 Focused Updates: ACC/AHA Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction.
Available at:
http://circ.ahajournals.org/content/117/2/296.full.pdf
2004 AHA/ACC Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction – Executive
Summary. Available at:
http://circ.ahajournals.org/content/110/5/588.full.pdf+html
2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of
Cardiology Foundation/American Heart AssociationTask Force on Practice Guidelines and the Society for
Cardiovascular Angiography and Interventions. Available at:
http://circ.ahajournals.org/content/early/2011/11/07/CIR.0b013e31823ba622
Supplemental Readings:
Wallentin L. P2Y(12) inhibitors: differences in properties and mechanisms of action and potential consequences for
clinical use. Eur Heart J 2009;30(16):1964-77.
Study Guide Questions:
1. Please refer to figure 1 of the 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007
Guidelines for the Management of Patients With Unstable Angina/Non-ST Elevation Myocardial Infarction
(NSTEMI) guidelines and other relevant materials:
Describe the differences among unstable angina, NSTEMI and STEMI in terms of symptoms on presentation,
ECG changes and cardiac enzyme changes.
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2. Please refer to figure 3 of the 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007
Guidelines for the Management of Patients With Unstable Angina/Non-ST Elevation Myocardial Infarction
(NSTEMI) guidelines and other relevant materials:
How many sublingual nitroglycerin tablets should patient self-administer before calling 911 for help?
3. Please describe the differences of creatinine kinase (CK), CK-MB and Troponin and why all three tests need
to be performed to aid a diagnosis of ACS.
4. According to the 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the
Management of Patients With Unstable Angina/Non-ST Elevation Myocardial Infarction (NSTEMI) guidelines,
what are the anti-ischemic/analgesic agents that should be considered in patients with unstable
angina/NSTEMI during early hospital care?
5. According to the 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the
Management of Patients With Unstable Angina/Non-ST Elevation Myocardial Infarction (NSTEMI) guidelines,
morphine is no longer considered an analgesic of choice in ACS unless patient is refractory/contraindicated to
other anti-ischemic agent. What is the rationale?
6. According to the 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the
Management of Patients With Unstable Angina/Non-ST Elevation Myocardial Infarction (NSTEMI) guidelines,
why should non-steroidal anti-inflammatory agents and COX-2 inhibitors be avoided in patients with ACS?
7. Please differentiate the pharmacologic profile of aspirin, clopidogrel, prasugrel, ticagrelor and glycoprotein
IIb/IIIa receptor antagonists. In terms clopidogrel, prasugrel and ticagrelor, what is the comparative clinical
efficacy and side effects of these agents?
8. Please differentiate the pharmacologic profile of heparin, low-molecular weight heparin, fondaparinux, and
bivalirudin.
9. According to the 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the
Management of Patients With Unstable Angina/Non-ST Elevation Myocardial Infarction (NSTEMI) guidelines,
what are the antiplatelet/anticoagulant that should be considered in patients with unstable angina/NSTEMI
during early hospital care (disregard of whether they will be going for percutaneous coronary intervention
[PCI])?
10. According to 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Interventions, section 5.7 on
Interventional Pharmacotherapy, what antiplatelet regimen should patients be receiving prior to performing PCI
(please list all options)?
11. According to 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Interventions, section 5.7 on
Interventional Pharmacotherapy, what antiplatelet and anticoagulant regimen should patients be receiving
during PCI? What is the advantage/disadvantage of one option versus another.
12. According to 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Interventions, section 5.7 on
Interventional Pharmacotherapy, what antiplatelet regimen (drug, dosage and duration of therapy) should
patients be receiving after PCI if: 1. No coronary stent has been placed; 2. A bare metal stent has been
placed; 3. A drug eluting stent has been placed?
13. According to 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Interventions, what is the best
regimen to prevent contrast induced nephropathy from PCI?
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14. What are the absolute contraindications for prasugrel and ticagrelor therapy?
15. According to 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Interventions, in what type of
patients is proton pump inhibitors recommended to prevent gastrointestinal bleeding?
16. According to the 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the
Management of Patients With Unstable Angina/Non-ST Elevation Myocardial Infarction (NSTEMI) guidelines,
section 5.2 : “Long-term Medical Management and Secondary Prevention”, what medications should a patient
be discharged home on after an unstable angina/NSTEMI event?
17. According to the 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the
Management of Patients With Unstable Angina/Non-ST Elevation Myocardial Infarction (NSTEMI) guidelines,
how is the approach of using anti-anginal/analgesic agents differ in patients whose events are precipitated by
cocaine, methamphetamines or Prinzmetal angina?
18. According to the 2007 Focused Updates: ACC/AHA Guidelines for the Management of Patients with STElevation Myocardial Infarction, what special attention needs to be paid when deciding to use intravenous
beta-blockers in a STEMI patient?
19. According to the 2004 AHA/ACC Guidelines for the Management of Patients with ST-Elevation Myocardial
Infarction, what are the indications and contraindications for fibrinolytic therapy?
20. According to the 2004 AHA/ACC Guidelines for the Management of Patients with ST-Elevation Myocardial
Infarction, besides reperfusion therapy (either fibrinolysis or primary PCI), what adjunctive antiplatelet,
anticoagulant, anti-ischemic and other therapy should be administered to a patient with ST-elevation
myocardial infarction?
21. According to the 2004 AHA/ACC Guidelines for the Management of Patients with ST-Elevation Myocardial
Infarction, for patients who survive the acute phase of an ST-elevation myocardial infarction, what kind of
pharmacologic secondary prevention therapies should be recommended?
Dyslipidemia
Learning Objectives:
1. Describe the pathophysiologic process of developing atherosclerosis.
2. Identify patient specific risks factors for developing cardiovascular disease (CVD) according to the NCEP ATP III
guidelines and the 2004 update.
3. Differentiate the pharmacologic and pharmacokinetic properties of the various lipid lowering agents (i.e. HMG CoA
reductase inhibitors “statins”, fibric acid derivatives, nicotinic acid, ezitimibe, bile acid sequestrants, and fish oil).
Required Readings
Eaton CB. Hyperlipidemia. Prim Care. 2005;32(4):1027-55, doi:10.1016/j.pop.2005.09.002. Pages 127-133
Last AR, Ference JD, Falleroni J. Pharmacologic Treatment of Hyperlipidemia. Am Fam Physician. 2011;84(5):551-8.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the
Third Report of the The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and
Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-97.
Grundy SM, Cleeman JI, Bairey CN, Brewer B, Clark LT, Hunninghake DB, et al. Implications of recent clinical trials
for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004; 110: 227–229.
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Sidney SC, Allen J, Blair SN et al. AHA/ACC Guideline:AHA/ACC Guidelines for Secondary Prevention for Patients
With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update: Endorsed by the National Heart, Lung, and
Blood Institute. Circulation. 2006;113:2363-2372,doi:10.1161/CIRCULATIONAHA.106.174516.
Study Guide
1. Describe the pathophysiologic process associated with dyslipidemia
2. Describe the role of the various lipoproteins in atherosclerosis.
3. Describe the pharmacologic properties of the various lipid lowering agents (i.e. HMG CoA reductase inhibitors
“statins”, fibric acid derivatives, nicotinic acid, ezitimibe, bile acid sequestrants, and fish oil).
4. Evaluate the role of the various agents in primary and secondary prevention of cardiovascular disease.
5. Describe the components of the therapeutic lifestyle changes (TLC) approach to reduce the risk of coronary heart
disease (CHD).
6. Identify secondary causes of dyslipidemia.
7. List the risk factors used when determining a patient’s low-density lipoprotein cholesterol (LDL-C) goal.
8. List the coronary heart disease (CHD) risk equivalents as they relate to the goals of therapy for dyslipidemia.
9. List the primary and secondary goals of dyslipidemia
10. Describe the relationship between LDL reduction and coronary heart disease risk reduction.
11. Analyze the results of the Heart Protection Study (HPS) and describe how it impacted the NCEP ATP III
guidelines.
12. Analyze the results of PROVE-IT and describe how it impacted the NCEP ATP III guidelines.
13. Given a patient’s risk category, determine the patient’s LDL cholesterol goal.
14. List the dyslipidemia recommendations for goals of therapy for secondary prevention according to the current
AHA/ACCF guidelines.
15. Describe the pharmacologic recommendations for dyslipidemia in secondary prevention of vascular disease
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Hypertension Home Study Questions
Learning Objectives:
1. List the appropriate subjective and objective components of a patient hypertension database
2. Determine the therapeutic goals for a patient with hypertension
3. Given patient and agent related variable, determine appropriateness and place in therapy regarding
antihypertensive medications
Required Readings
Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure: the JNC7 Report. JAMA 2003;289:2560-72.
Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in HighRisk Patients N Engl J Med 2008; 359:2417-2428
Moser M and Setaro JF. Resistant or Difficult-to-Control Hypertension. N Engl J Med 2006;355:385-92.
Kessler CS and Joudeh Y. Evaluation and Treatment of Severe Asymptomatic Hypertension. Am Fam Physician.
2010;81(4):470-476.
Marik PE and Varon J. Hypertensive Crises: Challenges and Management. Chest 2007;131;1949-1962 [only pages
1949 to 1952]
Palmer BF. Renal Dysfunction Complicating the Treatment of Hypertension. N Engl J Med 2002;347:1256-1261
Study Guide
1.
Describe the benefit of lowering blood pressure.
2.
How is blood pressure diagnosed and classified?
3.
Explain the differences in blood pressure goals based on patient-related variables.
4.
What are the 3 major objectives when assessing a patient with hypertension?
5.
When assessing a patient with hypertension, list the appropriate components of a patient specific “hypertension
database”. Consider appropriate information that needs to be collected with regard to medical history, physical
exam, and laboratory tests.
6.
Define and describe target organ damage (TOD) as it relates to hypertension. Compare acute TOD vs. chronic
TOD.
7.
List common secondary causes of hypertension.
8.
List different lifestyle modifications used to lower blood pressure. Compare approximate systolic blood pressure
reductions that can be expected.
9.
For a patient with no compelling indications, how does the clinician decide on mono versus dual therapy? How
does the clinician decide between which agents to use first-line versus second-line?
10.
List the high risk compelling indications to consider when selecting a pharmacologic therapy for the patient with
hypertension? Describe which agents are useful for each compelling indication.
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11.
Compare the results of the ACCOMPLISH trial compare to the JNC VII guidelines and the answers to question 9
and 10?
12.
When should clinicians follow-up with patients who are being treated for hypertension that is uncontrolled?
Describe how the specific medication used influences this.
13.
Describe the relationship between intraglomerular pressure and mean arterial pressure in patients with normal
and chronic hypertension. How is this renal autoregulation mechanism related to interpreting serum creatinine
concentrations when starting an ACEI or ARB?
14.
Compare and contrast acceptable versus unacceptable increases in serum creatinine concentrations in patients
being treated with ACE inhibitors or ARBs. When should the ACEI or ARB be discontinued?
15.
Describe how the clinician can minimize the risk of hyperkalemia with regard to ACEI or ARB therapy. What is
the upper limit of serum potassium concentration that would necessitate discontinuation of ACEI or ARB
therapy?
16.
Describe the general approach to assessing and treating a patient with resistant or difficult-to-control
hypertension.
17.
List the risk factors for acute target organ damage in patients with severely elevated blood pressure.
18.
Differentiate the characteristics of patients with hypertensive emergency versus hypertensive urgency versus
symptomatic severe uncontrolled hypertension.
19.
List the most common causes of hypertensive urgency/emergency.
20.
When suspicious of the presence of acute target organ damage, describe what aspects of the review of systems
and physical exam can be helpful.
21.
Compare the principals of pharmacological treatment regarding patients with hypertensive emergency versus
hypertensive urgency versus symptomatic severe uncontrolled hypertension.
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SELF-STUDY POST TEST – 40 QUESTIONS
Instructions: The test must be completed by no later than May 26, 2012. Answers must be faxed to
NYSCHP at 518-456-9319. The home study portion must be completed in order to participate in the
live program. A passing score of 70% must be achieved on the self-study online exam. (Those failing to
achieve this score will be contacted prior to the program for discussion and remediation.)
Patient Case: Questions 1-2
J.P. is a 73-year-old male with nonischemic cardiomyopathy (EF 30-35%) presenting to the ED with an acute HF
exacerbation. His vital signs include: BP 145/80 mmHg, HR 92 bpm, RR 23 rpm, and O2 sat 96% on 4 L NC. Physical
examination reveals 16 cm JVD, RRR, crackles bilaterally, and 3+ bilateral lower extremity edema. He admits to a 20pound weight gain in the past 3 weeks since his carvedilol dose was increased and reports strict adherence to both
dietary restrictions and medications. In the ED, he has already received a 40 mg IV x 1 dose with minimal response in
urine output. Pertinent labs include potassium 4.1 mmol/L, BNP 950 pg/ml, BUN 41 mg/dl, and creatinine 1.5 mg/dl
(baseline). J.P.’s medications include enalapril 10 mg twice daily, carvedilol 12.5 mg twice daily, digoxin 0.125
mg/day, and furosemide 40 mg twice daily.
1. Based on the BNP result, J.P. is experiencing which one of the following?
a. Active myocardial ischemia.
b. Shortness of breath due to a noncardiac etiology.
c. Significant volume overload and ventricular wall stretch.
d. Renal insufficiency.
2. Which one of the following interventions is the best for J.P. on arrival to the ICU?
a. Dobutamine 2.5 mcg/kg/minute infusion.
b. Milrinone 0.375 mcg/kg/minute infusion.
c. Furosemide 80 mg IV twice daily.
d. Metolazone 10 mg PO now and then daily.
Patient Case: Questions 3-4
A.L. is a 68-year-old woman complaining of “always tired these days.” Her exercise tolerance is significantly less than
it was 3 months ago; she now has to rest during daily activities. This has come on gradually. She has a history of
hypertensive cardiomyopathy (LVEF 30%). She is compliant with both diet restrictions and medications and her
daughter confirms such as she prepares all meals for A.L. and fills her pillbox weekly. Vital signs include BP 92/57
mmHg, HR 95 bpm, (mild orthostasis), and RR 16 rpm. A.L. has no complaints of dizziness or palpitations and her
ECG is normal. On physical examination, she has no jugular venous distention, clear lungs, and no ascites or lower
extremity edema. Laboratory analysis reveals sodium 132 mmol/L, potassium 3.9 mmol/L, BUN 65 mg/dl, and SCr 1.8
mg/dl (baseline BUN/SCr 32/0.9). A.L. has been stable on the following oral regimen for several months: valsartan 80
mg twice daily, metoprolol XL 50 mg/day, furosemide 40 mg twice daily, amiodarone 200 mg/day, and digoxin 0.125
mg/day.
3. Which one of the following clinical categories best describes A.L.?
a. Warm and dry.
b. Warm and wet.
c. Cold and dry.
d. Cold and wet.
4. Which one of the following is the optimal initial intervention for A.L.?
a. Change furosemide to 80 mg intravenously twice daily.
b. Hold furosemide and begin cautious hydration with intravenous fluids.
c. Hold metoprolol and begin dobutamine at 2 mcg/kg/minute.
d. Increase metoprolol XL to 100 mg/day.
5. Which of the following would be a contraindication to intravenous vasodilators?
a. Heart rate greater than 90 bpm
b. Heart rate greater than 110 bpm
c. Systolic blood pressure less than 90 mmHg
d. Systolic blood pressure less than 110 mmHg
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6. Which of the following are well-known adverse effects of dobutamine?
a. Hyponatremia
b. Renal dysfunction
c. Hyperkalemia
d. Arrhythmia
7.
Which of the following is referred to as an “inodilator”, having both inotropic
and vasodilatory properties?
a.
Milrinone
a. Dobutamine
b. Nesiritide
c. Nitroprusside
Patient Case: Questions 8
M.J. is a 45-year old male (70 kg) admitted for ADHF refractory to aggressive outpatient titration of oral diuretics
including torsemide and metolazone. He is now receiving intravenous furosemide 30 mg/hr and chlorothiazide 500 mg
twice daily. While M.J.’s vital signs and renal function appear stable (BP 110/65 mmHg, HR 85 bpm, SCr 1.3 mg/dL),
his urine output is unchanged despite over 24 hours of the above regimen and review of continuous telemetry
demonstrate multiple 20 beat runs of ventricular tachycardia.
8. Which of the following is an appropriate next step in therapy?
a. Initiate milrinone 0.1 mcg/kg/min
b. Initiate dobutamine 2.5 mcg/kg/min
c. Initiate nesiritide 0.01 mcg/kg/min
d. Increase furosemide to 60 mg/hr
9. JB is a 45-year old male with cardiomyopathy (LVEF 35%) following an acute MI. Immediately following his MI, he
developed signs and symptoms of HF including SOB at rest. Which of the following best characterizes JB’s
current ACC/AHA HF stage and New York Heart Association (NYHA) class?
a.
Stage A, NYHA class not applicable
b.
Stage B, NYHA class I
c.
Stage C, NYHA class II
d.
Stage C, NYHA class IV
Patient Case: Question 10
AF is a 63 YO female with HF (NYHA class I) receiving furosemide 40 mg twice daily, lisinopril 10 mg daily, metoprolol
XL 50 mg daily, digoxin 0.125 mg daily, and spironolactone 25 mg daily. During her routine clinic visit today, pertinent
findings include: BP 120/80, HR 70, RR 14, K+ 5.1 mmol/L, BUN 35 mg/dL, creatinine 1.2 mg/dL (baseline), and SDC
0.7 ng/mL.
10.
a.
b.
c.
d.
Which of the following is the most appropriate change to optimize AF’s medical regimen?
Increase ACE inhibitor dose
Increase beta blocker dose
Increase digoxin dose
Increase spironolactone dose
Cardiology Practiced Based CE Program ©
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Patient Case: Questions 11-14
I.H. is a 54-year old African American male with systolic heart failure presenting with a 2 week history of shortness of
breath which limits his normal daily activities and increased lower extremity edema. His weight has recently increased
by 10 pounds. His physical exam is notable for BP 148/72, HR 88, RR 24, rales, and 3+ lower extremity edema.
Pertinent laboratory values include: sodium 138 mmol/L, potassium 5.4 mmol/L, BUN 35 mg/dl, creatinine 0.9 mg/dl,
and digoxin 2.1 ng/mL. Past medical history is significant for HTN, gout, COPD. Current medications include lisinopril
20 mg daily, diltiazem CD 120 mg daily, digoxin 0.250 mg daily salmeterol/fluticasone 250/50 2 puffs BID. I.H. recently
began taking naproxen 220 mg three times daily for gout pain.
11.In addition to counseling on salt and fluid restriction, which of the following pharmacologic options is most
appropriate for managing I.H.’s fluid overload?
a. Initiate hydrochlorothiazide 50 mg daily.
b. Initiate furosemide 40 mg twice daily.
c. Initiate metolazone 2.5 mg daily.
d. Initiate spironolactone 25 mg daily.
12. Within the following 24 hours, I.H. experiences a brisk diuresis with considerable improvement in HF signs and
symptoms. What additional medication changes should be considered?
a. Continue current regimen and initiate hydrochlorothiazide 50mg daily.
b. Continue current regimen and initiate spironolactone 25 mg daily.
c. Discontinue lisinopril and initiate combination hydralazine 25 mg and isosorbide dinitrate 20 mg three
times daily.
d. Discontinue over-the-counter naproxen and initiate colchicine 0.6mg TID until gout pain resolves.
13. Once optimal fluid status has been achieved, which of the following represents the best option to manage
I.H.’s hypertension?
a. Discontinue diltiazem and initiate amlodipine 5 mg daily.
b. Initiate carvedilol 3.125mg twice daily.
c. Discontinue diltiazem and initiate carvedilol 3.125 mg twice daily.
d. Initiate prazosin 2 mg daily.
14. What additional medication change should be considered to improve I.H.’s morbidity?
a. Increase lisinopril to 40 mg daily.
b. Reduce digoxin to 0.125 mg daily.
c. Initiate spironolactone 25 mg daily.
d. Initiate candesartan 4 mg daily.
Cardiology Practiced Based CE Program ©
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Patient Case: Questions 15-16
R.J. is a 71-year old female with a history of ischemic cardiomyopathy who presents to clinic with symptoms consistent
with NYHA class IV HF. Past medical histories include hyperlipidemia, diabetes mellitus, myocardial infarction, and
hypothyroidism. R.J. complains of progressive weight gain (approximately 6 pound increase since her previous visit 3
months ago), shortness of breath at rest, 2 pillow orthpnea, and occasional PND. Her physical exam is positive for 1+
pitting edema in her ankles and minimal JVD. Vital signs include BP 95/60 and HR 91. Laboratory results include:
potassium 3.6 mmol/L, BUN 39 mg/dL, and creatinine 1.4 mg/dL. R.J.’s current medications are levothyroxine 0.05
mg daily, furosemide 40 mg twice daily, lisinopril 20 mg daily, atorvastatin 40mg daily, aspirin 81mg daily, insulin
glargine 46 units as bedtime, and insulin aspart 6 units before meals.
15. Which of the following is the best treatment option to manage R.J.’s hypokalemia?
a. Continue furosemide 40 mg twice daily.
b. Increase furosemide to 80 mg twice daily
c. Initiate spironolactone 25 mg once daily.
d. Increase furosemide to 80 mg twice daily and initiate spironolactone to 25 mg once daily.
16. R.J. is approaching euvolemia and the medical team anticipates another 2-3 days of aggressive diuresis prior
to achieving euvolemia. Which of the following represents the next best option to manage R.J.’s heart failure?
a. Initiate metoprolol succinate 25 mg daily immediately.
b. Initiate metoprolol succinate 25 mg daily once euvolemia is achieved.
c. Initiate metoprolol tartrate 12.5mg BID immediately.
d. Initiate digoxin 0.25 mg daily.
17. Which of the following are absolute contraindications to the use of beta blockers?
a.
Asthma with active bronchospasm
b.
Diabetes
c.
Chronic obstructive pulmonary disease
d.
Peripheral vascular disease
18. Which of the following is an appropriate rationale to switch an ACE inhibitor to an ARB?
a. Hypotension
b. Renal dysfunction
c. Hyperkalemia
d. None of the above
Patient Case: Question 19
BR, a 51 yof (5’6”, 150 lbs), presents to the ED with palpitations, SOB, and exercise intolerance. She has a PMH of
type 2 DM, dyslipidemia, HTN, and paroxysmal AF. An ECG reveals AF with a heart rate of 72 bpm. An
echocardiogram performed in the emergency department reveals LVEF = 60%, no evidence of thrombus, and
moderate LVH. Her current medications include hydrochlorothiazide 25 mg po daily, metoprolol 50 mg po BID, EC
ASA 81 mg po daily, pravastatin 40 mg po daily, warfarin 2.5 mg po daily (has been on for 6 months), and glyburide 5
mg po BID. Pertinent labs include: K 4.5 mEq/L, SCr 2.0 mg/dl, INR 2.5. Her cardiologist decides to admit her to the
hospital for elective direct-current cardioversion since she has recently become increasingly symptomatic during
episodes of AF. The next day (Day #2), she is successfully restored to sinus rhythm with direct-current cardioversion.
The cardiologist would now like to start chronic antiarrhythmic therapy in this patient to maintain her in sinus rhythm.
Her vitals on Day #2 are BP 120/75 mmHg, HR 70 bpm.
19. Which of the following antiarrhythmic agents would be the MOST appropriate to use in this patient to maintain
her in sinus rhythm?
a.
b.
c.
d.
Amiodarone
Dofetilide
Flecainide
Sotalol
Cardiology Practiced Based CE Program ©
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Patient Case: Questions 20-22:
WR is a 60 yom (5’10”, 180 lbs) who presents to the cardiology clinic complaining of episodes of dizziness and
palpitations. When asked about the duration of symptoms, he states, “I really can’t remember when the symptoms
started, but they have been going on for 3-4 days.” He has a history of type 2 DM, COPD, HTN, and dyslipidemia. His
current medications include glipizide XL 10 mg po daily, lisinopril 20 mg po daily, simvastatin 40 mg po daily,
salmeterol inhaler 1 inhalation BID, ipratropium inhaler 2 inhalations QID, albuterol inhaler 2 inhalations q4-6h PRN
(uses 3-4 times/day). His vitals are:
BP 125/75 mmHg, HR 110 bpm. His physical exam reveals no evidence of JVD or pedal edema. He is A&O x 3.
Pertinent labs include: K 4.2 mEq/L, SCr 1.0 mg/dL. His current ECG shows AF, HR 115 bpm, QT interval 410 msec.
An echocardiogram performed 1 month ago revealed an EF of 55% with no evidence of LVH.
20.
WR?
a.
b.
c.
d.
Which of the following antithrombotic regimens would be MOST appropriate for stroke prevention in
Aspirin 325 mg po daily
Warfarin (goal INR = 2-3)
Dabigatran 75 mg po BID
Aspirin 325 mg po daily + clopidogrel 75 mg po daily
21.
Which of the following drug regimens would be MOST appropriate to control ventricular rate in this
patient?
a.
Amiodarone 400 mg po daily
b.
Digoxin 0.25 mg po daily
c.
Diltiazem 60 mg po TID
d.
Propranolol 40 mg po BID
22.
After 3 weeks of being on an appropriate ventricular rate-controlling medication, WR is feeling much
better and is now without any major complaints. During his follow-up visit to the cardiology clinic, the ECG
reveals AF and heart rate 70 bpm. His BP is 110/68 mmHg. His INR has consistently been 2.5-2.7 over the
past 3 weeks. Which of the following would be the MOST appropriate action to take at this time?
a.
Initiate flecainide to restore sinus rhythm.
b.
Increase the dose of the rate-control drug to better control the heart rate.
c.
Initiate sotalol to restore sinus rhythm.
d.
Do nothing.
23.
a.
b.
c.
d.
Which of the following statements regarding antiarrhythmic drugs is TRUE?
Dronedarone causes numerous drug interactions because it is a potent inducer of CYP3A4.
Patients must be hospitalized for at least 3 days when dronedarone therapy is initiated because of the
risk of torsades de pointes.
Liver function tests should be monitored on an annual basis in patients receiving amiodarone to
screen for hepatic dysfunction.
Amiodarone can increase serum digoxin concentrations by inhibiting
P-glycoprotein.
Cardiology Practiced Based CE Program ©
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Patient Case: Questions 24-25
J.Y. is an 86-kg, 87-year-old man with past medical history significant for type 2 diabetes mellitus and hypertension.
He was on metformin and lisinopril. He presents to the emergency department with substernal chest pressure and 2mm ST-segment depression in leads V2–V4. J.Y.’s vital signs include blood pressure 168/92 mm Hg and pulse rate
100 beats/minute, and he is afebrile. Laboratory results are significant for hemoglobin 12.8 g/dL, hematocrit 38%, SCr
1.8 mg/dL, and troponin is elevated. He is diagnosed of non-ST elevation myocardial infarction.
24. Which of the following regimens should be initiated in J.Y. on admission to the hospital disregard of
whether or not he will be going to for percutaneous coronary intervention (PCI)?
a. Aspirin, clopidogrel, metoprolol, IV nitroglycerin, unfractionated heparin, atorvastatin
b. Aspirin, clopidogrel, diltiazem, enoxaparin, atorvastatin
c. Aspirin, prasugrel, metoprolol, lisinopril
d. Ticagrelor, metoprolol, IV nitroglycerin, unfractionated heparin, atorvastatin
25. The interventional cardiologist recommends early PCI. Because of patient’s advanced age and poor renal
function, the cardiologist would like to use an antithtombotic regimen during PCI with the least risk of
bleeding. What of the following is the most appropriate antithrombotic regimen for J.Y.?
a. Enoxaparin
b. Fondaparinux plus abciximab
c. Bivalirudin
d. Unfractionated heparin plus eptifibatide
Patient Case: Questions 26-27
W.T. is a 57-year-old Hispanic man with past medical history significant for hypertension. He is brought to the
emergency department by ambulance complaining of 4 hours of substernal chest pressure at rest. W.T. states that
during the past 2 weeks, he noticed fleeting twinges of chest pressure after exertion, but these episodes were relieved
by rest. Last evening while walking his dog, he developed heavy chest pressure. Once home, he rested and took some
Maalox without relief of chest discomfort. He called 911. W.T. takes metoprolol XL 50 mg orally once daily for his
hypertension. The patient denies any recent trauma or bleeding tendencies. On physical examination, he is an obese
man in moderate distress. His vital signs include blood pressure 120/80 mm Hg and pulse rate 55 beats/minute, and
he is afebrile. His physical examination is significant for regular rate and rhythm and normal S1 and S2; his fecal occult
blood test is negative. He has no signs of acute heart failure. Electrocardiography (ECG) performed 5 minutes after
presentation to the ED reveals normal sinus rhythm with ST-segment elevation (STE) in the inferior leads. His
chemistry panel and complete blood cell count are normal, his serum creatinine (SCr) is 1.0 mg/dL, but his troponin,
creatinine kinase and CK-MB are elevated.
26.
a.
b.
c.
What type of acute coronary syndrome does W.T. has?
Unstable angina
Non-ST elevation myocardial infarction
ST elevation myocardial infarction
27. The hospital does not have a cardiac catheterization laboratory. Which of the following is the best regimen
to reduce mortality and reinfarction for W.T.?
a. Alteplase, aspirin, intravenous unfractionated heparin (UFH) bolus and infusion, oral metoprolol.
b. Aspirin, enoxaparin, oral metoprolol.
c. Aspirin, abciximab, intravenous UFH bolus and infusion, clopidogrel
d. Tenecteplase, aspirin, clopidogrel, enoxaparin, oral metoprolol.
28. Which of the following statement is correct regarding the comparative efficacy and side effects among
clopidogrel, prasugrel and ticagrelor?
a. Compared to prasugrel, ticagrelor significantly reduce vascular death, non-fatal myocardial infarction and
non-fatal stroke.
b. Compared to clopidogrel, prasugrel significantly increase risk of major hemorrhage.
c. Compared to prasugrel, clopidogrel significantly reduce the risk of cardiovascular death, non-fatal
myocardial infarction and non-fatal stroke.
d. Compared to ticagrelor, clopidogrel was associated with higher incidence of transient dyspnea and
bradycardia.
29.
a.
b.
c.
Which of the following components of cholesterol are atherogenic?
High-density lipoproteins and low-density lipoproteins
Low-density lipoproteins and triglycerides
Triglycerides and high-density lipoproteins
Cardiology Practiced Based CE Program ©
16
30.
a.
b.
c.
d.
e.
Which of the following disease states and/or medications can cause secondary dyslipidemia?
Anabolic steroids
Diabetes
Hypothyroidism
Protease inhibitors
All of the above
Patient Case: Question 31
A 60 yo Caucasian male presents to clinic for a follow-up visit. He has a PMH of HTN and dyslipidemia. His family
history is significant for heart disease (mother alive at 83 yo, DM and HTN; father deceased at age 54 from MI). His
social history is significant for occasional alcohol use (1 glass of wine with dinner) and he smokes ½ ppd. His
medications include valsartan 80mg PO daily.
Vitals: BP 136/82 mmHg; HR 70 bpm; RR 16 bpm; Ht 5’4”; wt 160 lbs
Labs (fasting) include:
TC = 260 mg/dL
TG = 215 mg/dL
HDL = 38 mg/dL
LDL = 179 mg/dL
31. What is this patient’s risk category and associated LDL goal?
a.
Moderate risk; LDL goal < 130 mg/dL
b.
Moderate risk; LDL goal < 160 mg/dL
c.
High risk; LDL goal < 100 mg/dL
d.
High risk; LDL goal < 130 mg/dL
Patient Case: Question 32
A 65 yom returns to clinic for a follow-up visit. He has a PMH of MI (1 week ago), HTN, dyslipidemia, and COPD. His
SH is significant for smoking 2-4 cigs/week (down from 2 ppd X 40 years). He has NKDA.
VS: BP 130/80 mmHg; HR 62 bpm; RR 12 bpm; Ht 6’2”; Wt 240 lbs
Labs (fasting, 1 week ago):
TC 189 mg/dL HDL 44 mg/dL
TG 195 mg/dL LDL: 106 mg/dL
32. Which of the following pharmacologic recommendations for dyslipidemia would be most appropriate at this
time?
a.
Atorvastatin 20mg PO daily
b.
Ezetimibe 10mg PO daily
c.
Fenofibrate 145mg PO daily
d.
Niacin XR 500mg PO daily
33.
Which of the following agents are recommended to reduce triglyceride levels in patients with severe
hypertriglyceridemia?
a.
Ezetimibe and niacin
b.
Niacin and simvastatin
c.
Simvastatin and fenofibrate
d.
Fenofibrate and omega-3 fatty acids
e.
Omega-3 fatty acids and ezetimibe
Patient Case: Question 34
A 45 y/o male patient with HTN was started on lisinopril 10mg once daily. Upon starting therapy his baseline SCr was
1.2 mg/dl and potassium was 4.5mEq/L. Four weeks later his blood pressure is above goal and his SCr is 1.5mg/dl
while his K+ is 5.0 mEq/L.
34. Which of the following is the best recommendation regarding his lisinopril therapy?
a. Discontinue therapy
b. Decrease to 5mg daily
c. Leave the dose unchanged
d. Increase to 20mg daily
35. A patient arrives to the clinic with the aid of their spouse complaining of recent onset of left sided weakness,
but not paralysis. You notice some slight facial dropping and difficulty breathing. The patient’s blood pressure
is 182/108 mmHg. The patient’s spouse tells you that the patient has not taken their blood pressure
medication in a few weeks. Which of the following describes the best course of action?
Cardiology Practiced Based CE Program ©
17
a.
b.
c.
d.
Triage the patient to the emergency room for treatment of hypertensive emergency
Have the patient sit for 5 minutes and recheck their blood pressure
Instruct the patient to take all of their blood pressure medications when they get home
Give the patient clonidine 0.1mg and reassess blood pressure in 30 minutes
36. Which of the following conditions best represents when it is appropriate to start dual therapy as initial
treatment for HTN?
a. A patient with CKD with a blood pressure of 154/88 mmHg
b. A patient with no compelling indications and a blood pressure of 156/86 mmHg
c. A patient with no compelling indications and a blood pressure of 146/98 mmHg
d. A patient at high risk of CAD and a blood pressure of 148/92 mmHg
Patient Case: Question 37
A 67 y/o African American female patient is reporting to her new primary care physician. She has a history of HTN,
CAD (s/p MI), and CKD. She has experienced angioedema while taking losartan. She is currently taking HCTZ 25mg
daily and amlodipine 10mg daily. Her blood pressure today is 138/86 mmHg.
37. What would be the best recommendation to make regarding treating the patients HTN?
a. Increase HCTZ to 50mg once daily
b. Start lisinopril 10mg once daily
c. Start metoprolol tartrate 12.5mg twice daily
d. The BP is at goal; make no changes
Patient Case: Question 38
JP is a 50 y/o Caucasian man with treatment resistant HTN and complaints of fatigue. He has NKDA and is currently
taking celecoxib 200mg twice daily, cholecalciferol 1000 IU daily, multivitamin daily, fluticasone nasal spray 2 sprays in
each nostril daily, lisinopril 40mg daily, carvedilol 25mg twice daily, chlorthalidone 25mg daily, and nifedipine ER
120mg daily. He currently weighs 270 lbs and is 6 feet tall. His basic metabolic panel and physical exam are within
normal limits with an eGFR of 86 ml/min.
38.
Which of the following are the most likely secondary causes of his HTN?
a. Sleep apnea and fluticasone
b. Renal disease and celecoxib
c. Sleep apnea and celecoxib
d. Renal disease and fluticasone
Cardiology Practiced Based CE Program ©
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Cardiology Self-Study Examination Answer Sheet June 2012
Complete the Examination Answer Sheet and fax to NYSCHP at 518-456-9319 no later than 5-26-2012
with the program evaluation.
Please print clearly or type: Statements of Continuing Pharmacy Education Credits will be obtained
on line at healthsystemce.org and Certificate of Achievements will be mailed to the address indicated
below within 6 weeks of the conclusion of the program:
Name
____________________________________ __________________ ________ ___________
Street Address
City
State
Zip Code
________________
Phone
_________________
Fax
_________________________________________
Email
Employer
Approximate time for complete self-study: ___________________________________________
Pharmacists Credit Designation:
The New York State Council of Health-system Pharmacists is accredited by the Accreditation Council for Pharmacy
Education as a provider of continuing pharmacy education. The self-study component of Cardiology Practice Based
Program is approved for 10 hours (1.0CEUs) of continuing pharmacy credit. The ACPE Universal Program Number
for the self-study is 0134-0000-12-041-H01-P. A statement of continuing pharmacy education credit will be
awarded upon successfully achieving a passing score of 70% or higher, statements of credit are available at
healthsystemce.org with the CE Code of C41. To earn a Certificate of Achievement for the complete certificate
training program, participants must also participate in the live program and successfully complete the final open
book examination with a score of 70% or higher.
Please circle one answer per number.
1
A
B
C
D
E
31
A
B
C
D
E
2
A
B
C
D
E
32
A
B
C
D
E
3
A
B
C
D
E
33
A
B
C
D
E
4
A
B
C
D
E
34
A
B
C
D
E
5
A
B
C
D
E
35
A
B
C
D
E
6
A
B
C
D
E
36
A
B
C
D
E
7
A
B
C
D
E
37
A
B
C
D
E
8
A
B
C
D
E
38
A
B
C
D
E
9
A
B
C
D
E
39
A
B
C
D
E
10
A
B
C
D
E
40
A
B
C
D
E
11
A
B
C
D
E
41
A
B
C
D
E
12
A
B
C
D
E
42
A
B
C
D
E
13
A
B
C
D
E
43
A
B
C
D
E
14
A
B
C
D
E
44
A
B
C
D
E
15
A
B
C
D
E
45
A
B
C
D
E
16
A
B
C
D
E
46
A
B
C
D
E
17
A
B
C
D
E
47
A
B
C
D
E
18
A
B
C
D
E
48
A
B
C
D
E
19
A
B
C
D
E
49
A
B
C
D
E
20
A
B
C
D
E
50
A
B
C
D
E
21
A
B
C
D
E
22
A
B
C
D
E
23
A
B
C
D
E
24
A
B
C
D
E
25
A
B
C
D
E
26
A
B
C
D
E
27
A
B
C
D
E
28
A
B
C
D
E
29
A
B
C
D
E
30
A
B
C
D
E
Cardiology Practiced Based CE Program ©
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Cardiology Self-Study Activity Evaluation for Pharmacists June
2012: Please fax with answers to 518-456-9319
Please evaluate the program using the following scale: 4- Excellent; 3- Good; 2- Fair; 1Poor.
A. Please rate this self-study activity for overall quality:
a. 4
b. 3
c. 2
d. 1
B.
How well did this self-study activity meet your individual educational needs for professional
development?
a. 4
b. 3
c. 2
d. 1
C.
Please rate
a.
b.
c.
d.
the effectiveness of the home study reading materials.
4
3
2
1
D.
Please rate
a.
b.
c.
d.
the appropriateness of the self-study and self-study exam questions.
4
3
2
1
E.
This self-study activity did not promote a particular product or company.
a. Agree
b. Disagree
F.
The information from the reading materials (please select all that apply):
a. Reinforced my current practice.
b. Will improve my practice/patient outcomes.
c. Provided new ideas or information I expect to use.
d. Enhances my current knowledge base.
G.
Will the information from the reading materials cause you to make any changes in your
practice?
a. Yes
b. No
H.
How committed are you to making these changes:
a. Very committed
b. Committed
c. Not very committed
d. Not at all committed.
I.
Do you feel future activities on the subject matter are necessary and/or important to your
practice?
a. Yes
b. No
J.
Did this self-study activity meet the stated learning objectives?
a. Yes
b. No
Cardiology Practiced Based CE Program ©
20
(If you indicated no please identify the learning objectives that were not met by the program.)
Additional comments:
New York State Council of
Health-system Pharmacists
210 Washington Avenue Extension,
Albany, NY 12203
518-456-8819
Cardiology Practiced Based CE Program ©
21