Therapy exam 2

70-99 mg/dL (fasting)

normal range of glucose in BMP

DM

stres

steroid meds

reasons for elevated glucose

high insulin

hypoglycemia

addisons disease

reasons for low glucose levels

8.5-10.2 mg/dL

normal calcium range in BMP

hyperparathyroidism

cancer

vitamin D toxicity

reasons for elevated calcium levels

HYPOparathyroidism

vitamin D deficiency

kidney disease

reasons for low calcium levels

135-145 mEq/L

normal sodium levels in BMP

dehydration

cushings syndrome

hyperaldosteronism

reasons for elevated sodium levels

diruetics

addisons disease

heart failure

reasons for low sodium levels

3.5-5.0 mEq/L

normal potassium range in BMP

kidney failure

ACEi

tissue damage

reasons for elevated potassium levels

diarrhea

diuretics

vomiting

reasons for low potassium levels

96-106 mEq/L

normal chloride range in BMP

dehydration

hyperventilation

metabolic ACIDosis

reasons for elevated chloride levels

vomiting

diuretics

metabolic ALKAlosis

resons for decreased chloride levels

22-29 mEq/L

normal carbon dioxide range in BMP

lung disease

vomiting

metabolic ALKAlosis

reasons for increased levels of carbon dioxide

diarrhea

kidney disease

metabolic ACIDosis

reasons for decreased CO2 levels

7-20 mg/dL

normal BUN (blood urea nitrogen)

kidney disease

dehydration

heart failure

reasons for increased BUN

liver disease

malnutrition

overhydration

reasons for decreased BUN

0.6-1.2 mg/dL

normal range of creatinine in BMP

kidney disease

muscle breakdown

increased protein intake

reasons for elevated creatinine

muscle wasting

low muscle mass

liver disease

reasons for decreased levels of creatinine

ask (about smoking habits)

advise (to quit)

assess (severity)

assist (therapy)

arrange (follow-up)

5 As for stopping smoking

0.5 mg QD days 1-3

0.5 mg BID days 4-7

1mg twice weekly for days 8+

standard dosing of varenicline/chantix

12 weeks

treatment duration of varenicline/chantix

YES

start at 0.5mg daily, max 0.5 mg BID

does chantix require renal dose adjustment

below 30

what does the CrCl have to be to decrease dose of chantix for renal failure

seizure disorder

major CI in bupropion/zyban

gum, lozenge, nasal spray

short - acting NRTs

4mg

starting dose of nicorette gum/lozenge for someone that has a cigarette within 30 mins of waking up

2mg

starting dose of nicorette gum/lozenge for someone who has cigarette more than 30 mins after waking up

24 pieces

max daily amount of nicorette gum

1 piece Q 1-2 hours x 6 weeks

1 piece Q 2-4 hours x 3 weeks

1 piece Q 4-8 hours x 3 weeks

dosing regimen of nicorette gum

20

max amount of nicorette lozenge per day

40 doses/day

max dose of nicotine nasal spray in a day

21 mg x 6 weeks

14 mg x 2 weeks

7 mg x 2 weeks

starting dose of nicotine patch for someone who smokes more than 10 cigarettes in a day

14 mg then 7mg x 2 weeks

starting dose of nicotine patch for someone who smokes <10 cigarettes per day

1-2 weeks before quit date

how early can you start zyban before someone quits smoking

BP= cardiac output x peripheral resistance

blood pressure equation

SBP

peak pressure during heart contraction

contraction of left ventricle

DBP

pressure during the time the chambers of the heart are filling (2/3 of time)

MAP = (SBP x 1/3) + (DBP x 2/3)

mean arterial pressure equation

kidneys

what organ regulates RAAS system

vasoconstriction

aldosterone secretion

increase sodium reabsorption

increased sympathetic outflow

release of vasopressin

effects of angiotenin II

cardiac output

primarly determines systolic BP

total peripheral resistance

primarily determines diastolic blood pressure

difference between SBP and DBP

pulse pressure

<5%

10 year low risk ascvd

5-7.4%

borderline ascvd risk

7.5-19.9%

intermediate ascvd risk

>20%

high ascvd risk

<150/90

BP goal for >80 years old

<150/90

BP goal for >60-65 year olds

5-20 mmHG reduction in SBP

affects of weight loss on BP

5-9 mmHg SBP decrease

effects of exercise on BP

2-4 mmHg decrease SBP

effects of limiting alcohol on BP

8-14 mmHG SBP decrease

effects of DASH diet on BP

5-6 mmHg decrease SBP

effects of reduced salt intake on BP

ACEi

ARB

MRAs

ARNIs

drug classes that directly affect RAAS system

atenolol, bisoprolol, metoprolol, nebivolol

cardioselective beta blockers

nadalol, propanolol

nonselective beta blockers

carvedilol, labetalol

beta blockers that effect alpha & beta receptors

ACEi/ARB

then add beta blocker

diuretic if edema is present

drug classes to treat HFrEF

beta blocker OR

ACEi/ARB

diuretic if edema is present

drug classes to treat HFpEF

beta blocker

then add ACEi/ARB

CCB if angina

drug classes for stable ischemic heart disease

5 mg

initial daily dose of enalapril

10 mg

initial daily dose of lisinopril

50 mg

initial daily dose of losartan

40-80 mg

initial daily dose of valsartan

50 mg

initial daily dose of metoprolol

2.5 mg

intiial daily dose of amlodipine

120-180 mg

initial daily dose of diltiazem XR

12.5 mg

initial daily dose of chlorthalidone

methyldopa

labetalol - beta blockers (not atenolol)

nifedipine

treatment of pregnant HTN