Pharm quiz 4

What five characteristics define Metabolic Syndrome?

Type 2 diabetes, abdominal obesity, hypertriglyceridemia, low HDLs, and hypertension.

According to the text, what is the greatest contributor to Metabolic Syndrome?

Lifestyle.

The condition involving insulin resistance and obesity is sometimes referred to by what two alternative terms?

Diabesity and insulin resistance syndrome.

What is the primary vascular consequence of the insulin resistance seen in type 2 diabetes?

Vascular damage that induces atherosclerosis.

Lifestyle changes alone can delay the onset of type 2 diabetes mellitus by more than what percentage?

More than $50\%$.

What is the recommended daily duration for moderate-intensity physical activity like walking to modify lifestyle risk?

$60$ minutes.

What is the target blood pressure goal for patients with Metabolic Syndrome?

Less than $130/80$ $mm$ $Hg$.

To treat dyslipidemia, what is the target goal for Low-Density Lipoproteins (LDLs)?

Less than $100$ $mg/dL$.

What is the target level for triglycerides in the treatment of lipids?

Less than $150$ $mg/dL$.

What is the target HDL level for men to reduce cardiovascular risk?

Higher than $40$ $mg/dL$.

What is the target HDL level for women to reduce cardiovascular risk?

Higher than 50 mg/dL

What is the target Hemoglobin A1c percentage for monitoring 3-month blood sugar trends?

Less than 7%

What is the target range for fasting plasma glucose in metabolic syndrome management?

Less than $120$ $mg/dL$.

What is the target for postprandial (after eating) plasma glucose?

Less than $180$ $mg/dL$.

Define atherosclerosis.

The accumulation of fatty deposits on inner walls of arteries that reduces blood supply to organs.

What percentage of the US population is estimated to die from a heart attack or stroke associated with ASCVD?

Almost one-third.

What is the major treatable cause of atherosclerosis?

Hyperlipidemia.

Which lipoprotein class converts dietary fat into cholesterol?

Triglycerides.

Which lipoprotein accounts for 60% to 70%of total serum cholesterol and is the major contributor to atherosclerosis?

Low-density lipoproteins (LDLs).

What are the three primary Therapeutic Lifestyle Changes (TLCs) recommended as primary treatment for hyperlipidemia?

Weight reduction, exercise, and a diet low in cholesterol and fat.

How long after initiating antilipemic therapy should a lipid panel be repeated?

4 to 12 weeks.

How often is a fasting lipoprotein profile recommended for all adults older than 20 years?

Every 5 years.

What is the mechanism of action for HMG-CoA Reductase Inhibitors (Statins)?

They inhibit the enzyme responsible for converting HMG-CoA to mevalonate, reducing liver cholesterol.

Statins: Normal Adverse Effects

Headaches, nausea, abdominal bloating, and gas.

Statins: Serious Adverse Effects

Liver dysfunction, myopathy, and rhabdomyolysis.

Why are statins best administered at night?

Because peak cholesterol production occurs at that time.

Which dietary substance inhibits the metabolism of several statins and must be avoided?

Grapefruit juice.

What are the early clinical signs of myopathy caused by statin therapy?

Muscle aches, soreness, and weakness.

What is rhabdomyolysis?

Kidney damage resulting from progressing myopathy, often indicated by pinkish or red-tinged urine.

At what level of AST or ALT elevation should statin medication be discontinued?

$3$ times the normal level.

List three examples of Bile Acid-Binding Resins.

Cholestyramine, colestipol, and colesevelam.

Bile Acid-Binding Resins: Normal Adverse Effects

Constipation, bloating, fullness, nausea, and flatulence.

What rare but serious adverse effect is associated with high doses of bile acid-binding resins?

Vitamin K deficiency.

Which bile acid-binding resin is FDA-approved for reducing blood glucose and $HbA1c$ in type 2 diabetes patients?

Colesevelam.

Which four fat-soluble vitamins may have reduced absorption due to bile acid-binding resins?

Vitamins A, D, E, and K.

Niacin: Mechanism of Action

Inhibits VLDL synthesis by liver cells.

Niacin: Normal Adverse Effects

Flushing, itching, rash, tingling, headache, and GI discomfort.

Niacin: Serious Adverse Effects

Hepatotoxicity and myopathy.

Which form of Niacin has a greater possibility of causing hepatotoxicity?

Extended-release products.

What can a patient take 30 minutes before Niacin to reduce symptoms like flushing?

Aspirin (325 mg) or ibuprofen (200 mg).

List two generic drugs and their brand names in the Fibric Acid class.

Gemfibrozil (Lopid) and fenofibrate (Tricor).

Fibric Acids: Serious Adverse Effects

Hepatotoxicity and early symptoms of gallbladder disease.

Which drug-drug combination significantly increases the risk of myopathy when treating hyperlipidemia?

Fibric acids used in conjunction with statins.

Ezetimibe: Generic Name and Mechanism of Action

Brand: Zetia; Action: Blocks absorption of cholesterol from the small intestine.

With which drug class should Ezetimibe (Zetia) NOT be used?

Fibric acids.

Omega-3 Fatty Acids: Brand Name and Use

Brand: Lovaza; Use: To decrease elevated triglyceride levels.

What is the primary safety advantage of Omega-3 fatty acids over fibrates or niacin when combined with statins?

They do not cause myositis or rhabdomyolysis.

How is Pulse Pressure calculated?

The difference between systolic and diastolic blood pressures.

What is the classification of Primary Hypertension?

Hypertension with an unknown cause, representing $90\%$ of cases.

Define 'Normal' Blood Pressure for adults.

$<120$ systolic and $<80$ diastolic.

Define 'Elevated' Blood Pressure for adults.

$120-129$ systolic and $<80$ diastolic.

Define 'Stage 1' Hypertension.

$130-139$ systolic or $80-89$ diastolic.

Define 'Stage 2' Hypertension.

$\ge 140$ systolic or $\ge 90$ diastolic.

What dietary plan is specifically recommended for managing hypertension?

The DASH (Dietary Approaches to Stop Hypertension) diet.

Patients with hypertension and chronic kidney disease should primarily be treated with which two drug classes?

ACE inhibitors or ARBs.

What nursing instruction is given for leg exercises in hypertensive patients?

Perform them to prevent blood pooling in the legs.

Diuretics: Mechanism of Action in HTN

Cause volume depletion, sodium excretion, and vasodilation of peripheral arterioles.

Beta-Adrenergic Blocking Agents: Normal Adverse Effects

Bradycardia, peripheral vasoconstriction (mottled skin), and masks hypoglycemia symptoms.

Beta-Adrenergic Blocking Agents: Serious Adverse Effects

Heart failure and bronchospasm/wheezing.

Under what two vital sign conditions should a beta blocker be held?

Systolic BP $< 100$ $mm$ $Hg$ or heart rate $< 60$ bpm.

What is the risk of sudden discontinuation of beta blocker therapy?

Worsening angina or myocardial infarction.

Beta blockers are generally noted as not being effective in which specific demographic?

African Americans.

ACE Inhibitors: Mechanism of Action

Inhibit the conversion of angiotensin I to angiotensin II.

ACE Inhibitors: Common Adverse Effect occurring in $1/3$ of patients

A chronic cough.

ACE Inhibitors: Serious Adverse Effects

Angioedema, hyperkalemia, neutropenia, and nephrotoxicity.

Define Angioedema.

Swelling of the face, eyes, lips, and tongue, causing difficulty breathing.

Angiotensin II Blockers (ARBs): Mechanism of Action

Bind to and block angiotensin II receptor sites in target organs.

ARBs: Serious Adverse Effects

Hyperkalemia and birth defects.

Direct Renin Inhibitor: Generic Name and Serious Effects

Drug: Aliskiren (Tekturna); Effects: Altered fluid/electrolytes and birth defects.

Aldosterone Receptor Antagonist: Generic Name and Brand Name

Eplerenone (Inspra).

Eplerenone (Inspra): Serious Adverse Effects

Hyperkalemia, hepatotoxicity, nephrotoxicity, and gynecomastia.

Calcium Channel Blockers: Serious Adverse Effects

Hypotension, syncope, and edema.

Which antihypertensive class is specifically noted as effective for African American patients?

Calcium Channel Blockers.

Alpha-1 Adrenergic Blocking Agents: Common Adverse Effects

Drowsiness, headache, dizziness, tachycardia, and fainting.

Central-Acting Alpha-2 Agonists: Serious Adverse Effects

Depression and rash.

What is the danger of abruptly discontinuing Clonidine?

Rebound effects with severely increased blood pressure, nervousness, and agitation.

Direct Vasodilators: Generic names

Hydralazine, minoxidil, and nitroprusside sodium.

Direct Vasodilators: Serious Adverse Effects

Fever, chills, joint/muscle pain, skin eruptions, and gynecomastia.

What is the natural pacemaker of the heart?

The sinoatrial (SA) node.

Trace the heart's electrical conduction pathway starting from the SA node.

SA node $\rightarrow$ Atria $\rightarrow$ AV node $\rightarrow$ Bundle of His $\rightarrow$ Bundle branches $\rightarrow$ Purkinje fibers.

Which three ions conduct electrical impulses in the heart?

Sodium, calcium, and potassium.

Where do supraventricular dysrhythmias develop?

Above the bundle of His.

List the Six Cardinal Signs of cardiovascular disease.

Dyspnea, chest pain, fatigue, edema, syncope, and palpitations.

Class Ia Antidysrhythmic: Generic Name and Serious Effects

Drug: Quinidine; Effects: Myocardial toxicity, urinary hesitancy, and constipation with distention.

Class Ib Antidysrhythmic: Generic Name and Serious Effects

Drug: IV Lidocaine (Xylocaine); Effects: Dysrhythmias, neurotoxicity, seizures, and confusion.

What specific label must be present on Lidocaine used for cardiac issues?

Lidocaine for Dysrhythmia.

Class Ic Antidysrhythmic: Generic Name and Serious Effects

Drug: Propafenone (Rhytmol); Effects: Visual disturbances, increasing dyspnea, edema, and dysrhythmias.

Class II Antidysrhythmics: Generic Names

Esmolol (Brevibloc) and metoprolol (Lopressor).

Class III Antidysrhythmic: Generic Name and hospitalization requirement

Amiodarone hydrochloride (Cordarone); patients must be hospitalized during the loading dose.

Amiodarone: Serious Respiratory and Integumentary Effects

Pulmonary interstitial pneumonitis and blue-gray skin coloration.

Amiodarone: Visual Adverse Effects

Pigmentations in the cornea and corneal microdeposits.

Class IV Antidysrhythmics: Generic Names

Verapamil (Calan) and diltiazem (Cardizem).

Adenosine (Adenocard): Administration method and dosing

Rapid IV bolus; $6$ $mg$ then $12$ $mg$.

Digoxin (Lanoxin): Generic Name and Action

Action: Slows conduction through the AV node and increases cardiac output.

List four visual symptoms of Digoxin toxicity.

Blind spots, yellow vision (xanthopsia), seeing spots, and blurred vision.

List four non-visual signs of Digoxin toxicity.

Confusion, irregular pulse, loss of appetite, and nausea/vomiting/diarrhea.