JF is a 64 year old African American male who is transferring to your practice. He has no complaints, except for occasional headaches and some lightheadedness when getting up too quickly over the past month. He admits to minimal exercise and states “I don’t add salt to my food”. His last visit to his PCP was 9 months ago.
PMH: HTN, Type II Diabetes, COPD
SH- occasional alcohol, 2-3 cups tea daily, smokes socially when going out.
Current meds: Hydrochlorothiazide 25 mg daily; Insulin glargine 20U daily hs; Metformin 1000 mg BID, tiotroprium (Spiriva) 1 capsule inhaled daily.
VS: 162/90 (sitting), HR 76, RR 16. Ht. 70” Weight 190 lbs. pulse ox 96%
Would you change his antihypertensive medications? If so, what would you change?
Provide the rationale using an evidenced base source for your choice.
List five things you would teach this patient?
In addition, please answer one of the following (questions 1-9):
1. Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with what cardiac condition?
2. Why are ACE inhibitors the drug of choice in people with diabetes?
3. Discuss Coumadin and the importance of knowing it has a low therapeutic index
4. Why does Warfarin resistance occur in patients with VKORC1 mutation and how does that affect prescribing?
5. A patient is on warfarin (Coumadin) which is a Vitamin K antagonist. Your patient has a significant drop in their INR. They reveal to you an increase in Vitamin K in their diet. How does the FNP explain what is happening that caused this decrease in INR?
6. A patient has toxic levels of an alkaline drug in his blood. In order to accelerate excretion, what does the NP administer?
7. What lab studies should be done with your patients on ARB’s or ACE inhibitors?
8. How does Narcan work against opioids?
I have also included some additional questions below (questions 9-12). You do not have to answer these for the discussion. However, discussing and reviewing these questions will better prepare you for the upcoming exam!
9. Mr. Morris is currently taking carvedilol (Coreg), a beta blocker, for his hypertension. This medication is metabolized via the CYP2D6 enzyme (CYP450 system) pathway. He presents to a psychiatrist for depression and is started on paroxetine (Paxil), an antidepressant and a potent CYP2D6 inhibitor. The NP is aware that which of the following effects could occur?
10. Your patient has accidentally taken too much heparin. In order to counteract its effect, you administer protamine sulfate, which forms an ionic bond with heparin. What is this type of antagonism called?
11. Your patient has decreased liver function. How does this affect the volume of distribution of a highly protein-bound medication?
12. How do beta blockers treat hypertension? Write a sample prescriiption for your patient using any beta blocker?
