FNP Primary Care First-Line Management Guide (Ages 40-60)

Vocabulary flashcards outlining primary care first-line management, pharmacotherapy classes, monitoring schedules, and clinical red flags for adults aged 40 to 60 years.

Four-Step Clinical Decision Framework

The systematic clinical process consisting of: 1. Safety (urgency/stability), 2. Confirmation (diagnosis and severity), 3. Choice (factors like renal, cardiac, pregnancy, interactions, cost), and 4. Follow-up (monitoring parameters, timing, adverse effects).

Stage 2 Hypertension Initial Management

For average blood pressure measurements $\ge 140/90\,\text{mmHg}$, the 2025 guideline recommends initiating two first-line drug classes alongside lifestyle modifications to reach a target of $< 130/80\,\text{mmHg}$.

Thiazide Diuretics

First-line antihypertensive agents (e.g., chlorthalidone, indapamide, hydrochlorothiazide) that promote sodium and water excretion; requires monitoring of sodium, potassium, kidney function, and gout.

ACE Inhibitors (ACEI)

Angiotensin-converting enzyme inhibitors ending in "-pril" (e.g., lisinopril, enalapril) used for hypertension; essential monitoring includes cough, angioedema, serum potassium, and creatinine.

Angiotensin II Receptor Blockers (ARBs)

Antihypertensive agents ending in "-sartan" (e.g., losartan, valsartan) favored in patients with albuminuria; require monitoring of potassium and creatinine, and must not be combined with ACE inhibitors or used in pregnancy.

Dihydropyridine Calcium Channel Blockers (CCBs)

First-line antihypertensive medications such as amlodipine and extended-release nifedipine; primary adverse effects to monitor are peripheral edema and headache.

Metformin

A biguanide that serves as a common, low-cost initial therapy for type 2 diabetes without cardiorenal priority; contraindicated when $\text{eGFR} < 30\,\text{mL/min/1.73 m}^2$ and not recommended to initiate when $\text{eGFR}$ is between $30\text{--}44\,\text{mL/min/1.73 m}^2$.

SGLT2 Inhibitors

Sodium-glucose cotransporter 2 inhibitors (e.g., empagliflozin, dapagliflozin) that increase urinary glucose excretion; favored in heart failure or chronic kidney disease; requires patient education on volume depletion, genital infections, and ketoacidosis.

GLP-1 Receptor Agonists

Glucagon-like peptide-1 receptor agonists (e.g., semaglutide, dulaglutide) with proven benefit for type 2 diabetes with cardiovascular disease, high cardiovascular risk, or when weight loss is prioritized; associated mainly with gastrointestinal effects.

Tirzepatide

A dual GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 receptor agonist utilized in type 2 diabetes when obesity management is a leading priority.

Marked Hyperglycemia Criteria

Clinical presentation in type 2 diabetes characterized by symptoms of catabolism, an $\text{A1c} > 10\%$, or blood glucose $\ge 300\,\text{mg/dL}$, which guides the consideration of insulin therapy and ruling out acute decompensation.

Levothyroxine

Synthetic T4 hormone replacement used as first-line treatment for hypothyroidism; taken consistently $30\text{--}60$ minutes before breakfast and separated from iron or calcium supplements by at least $4$ hours.

Primary Hypothyroidism Follow-Up

Monitoring protocol requiring laboratory assessment of TSH at $6\text{--}8$ weeks after initiating or titrating levothyroxine (TSH is not equally useful for titration in central hypothyroidism).

Methimazole

A thionamide antithyroid medication that reduces thyroid hormone synthesis in Graves' disease; requires baseline complete blood count (CBC) and liver function tests.

Propylthiouracil (PTU)

A thionamide antithyroid drug designated as a specialized option during the first trimester of pregnancy; carries an important risk of hepatotoxicity.

Beta-blockers in Hyperthyroidism

Adjuvant agents (propranolol, atenolol, metoprolol) used to alleviate tremor and palpitations by blunting sympathetic tone; they do not reduce excess thyroid hormone synthesis.

Thionamide-Induced Agranulocytosis

A critical potential adverse effect heralded by fever or sore throat in patients taking methimazole or PTU, necessitating prompt medication cessation and an urgent CBC evaluation.

Statins (HMG-CoA Reductase Inhibitors)

First-line lipid-lowering agents (e.g., atorvastatin, rosuvastatin) selected by cardiovascular risk; recommended for patients with diabetes aged $40\text{--}75$ years, with repeat lipid panels checked at $4\text{--}12$ weeks.

Proton Pump Inhibitors (PPIs)

First-line agents ending in "-prazole" (e.g., omeprazole, pantoprazole) for frequent typical GERD symptoms without alarm features; taken $30\text{--}60$ minutes before meals and reevaluated at approximately $8$ weeks.

GERD Alarm Features

Clinical red flags comprising dysphagia, gastrointestinal bleeding, and unexplained weight loss that necessitate diagnostic investigation rather than routine empirical management.

Selective Serotonin Reuptake Inhibitors (SSRIs)

First-line medications (e.g., sertraline, escitalopram) for moderate-to-severe depression; requires ruling out bipolar disorder prior to initiation and early reassessment at $1\text{--}2$ weeks for safety and tolerance.

Topical NSAIDs

First-line pharmacotherapy for knee osteoarthritis (e.g., topical diclofenac) used alongside exercise; minimizes systemic adverse effects on the kidneys, blood pressure, heart, and gastrointestinal tract.