ACPE Accredited** Home Study: Acute Care Pharmacotherapy Cardiology. 7 CE Hours
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Question 1 of 25
1. Question
PM is a 78-year-old female who presented to the emergency department (ED) with radiating chest pain that started 3 hours ago. A 12-lead ECG showed ST segment depression in leads I, II, V4-6. She has a history of prior stroke and hypertension but states she has never experienced these symptoms before. Her vital signs include a heart rate of 118 beats/min, blood pressure of 110/58 mm Hg (mean arterial pressure [MAP] 75 mm Hg), respiratory rate of 22 breaths/min, and oxygen saturation of 98%. PM has no allergies, takes amlodipine 10 mg daily, and weighs 90 kg.
Laboratory findings include the following: blood glucose (BG) 150 mg/dL, Na 148 mmol/L, K 3.7 mmol/L, serum creatinine 1.3 mg/dL, Cl 101 mmol/L, bicarbonate 20 mmol/L, pH 7.35, Mg 1.5 mg/dL, and high sensitivity troponin T 115.8 ng/L.
Recent interventions include aspirin 325 mg x 1, heparin 4000 units IV x 1, and sublingual nitroglycerin 0.4 mg titrated to chest pain relief and blood pressure. What is the most appropriate antiplatelet treatment strategy for this patient with acute coronary syndrome (ACS) with a planned intervention?
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Question 2 of 25
2. Question
MP, a 62-year-old hypertensive male, presents to the emergency department with radiating chest pain of severe intensity that initiated 3 hours prior. His vitals are heart rate: 118 beats/min, blood pressure: 110/58 mm Hg, respiratory rate: 23 breaths/min, and oxygen saturation: 97%. His history includes a single medication, amlodipine 10 mg daily. A 12-lead ECG reveals ST segment depression in leads I, II, V4-V6 denoting non-ST-elevation myocardial infarction (NSTEMI). Key lab results include high-sensitivity troponin T at 115.8 ng/L and serum creatinine of 1.3 mg/dL.
Given that he is likely to undergo ischemia-guided conservative management for NSTEMI, which is the most suitable anticoagulant for MP?
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Question 3 of 25
3. Question
A 76-year-old man with no known drug allergies, presents to the emergency department with severe substernal chest pain of an hour’s duration. His blood pressure on admission is 130/80 mmHg, respiratory rate of 23 per minute, heart rate of 90 beats per minute and oxygen saturation of 96% on room air. He was on a morning walk when the sudden onset of pain prompted him to seek medical help. His ECG reveals ST elevations in leads II, III, avF, V5, and V6, suggestive of an acute ST-elevation myocardial infarction (STEMI). Despite being given nitroglycerin, the patient remains in significant pain and is extremely anxious. The clinician decides to commence morphine for pain control. What is the starting dosage range of morphine for this patient?
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Question 4 of 25
4. Question
What is the most appropriate recommendation for anticoagulation in a patient with non-ST-elevation myocardial infarction (NSTEMI) who is not a candidate for catheterization?
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Question 5 of 25
5. Question
A 58-year-old male patient with a past medical history of hypertension and hyperlipidemia is admitted to the emergency department, which is a comprehensive cardiac center. He reports experiencing severe chest pain that has been radiating to his left arm for the past hour. He also shares that he has smoked a pack of cigarettes a day for the past 20 years. His ECG reveals ST-segment elevation in leads II, III, and aVF. Given this patient’s presentation, which of the following reperfusion strategies aligns best with current guidelines and would be the most appropriate next step in management?
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Question 6 of 25
6. Question
A 58-year-old male with no past medical history presents to the ED with a blood pressure of 210/110 mmHg, severe headache, and nausea. There is a clinical suspicion of a hypertensive emergency. In treating his condition, the ED provider decides using clevidipine as the primary management. What is the recommended initial dose for clevidipine in this context?
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Question 7 of 25
7. Question
A 66-year-old male with a known history of hypertension arrives at the emergency department with a sudden surge in blood pressure, measured at 191/111 mmHg. He also presents with the symptoms of acute kidney injury and hyperkalemia. Considering his current condition, which of the below antihypertensive agents should be avoided due to its known associated risks of delayed unpredictable onset, prolonged duration of action (12-24), and potential exacerbation of his acute kidney injury and hyperkalemia?
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Question 8 of 25
8. Question
A 62-year-old male with a history of hypertension, currently uncontrolled, presents to the emergency department. His blood pressure is recorded as 220/120 mmHg and upon physical examination, you notice signs indicative of hypertensive emergency. You decide to initiate a nitroprusside drip to rapidly reduce his blood pressure. Which of the following is most accurate about the use of nitroprusside in this situation?
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Question 9 of 25
9. Question
A 56-year-old male with a history of uncontrolled hypertension is brought to the emergency department experiencing severe headaches, shortness of breath, and blurred vision. His blood pressure measures 220/130 mmHg, indicative of a hypertensive emergency. Which of the following medications provides the most rapid onset of action in reducing blood pressure during such hypertensive crises?
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Question 10 of 25
10. Question
A patient presents to the emergency department with a hypertensive emergency. The provider is considering the use of clevidipine as a pharmacological agent to manage their blood pressure. In which of the following patient populations is clevidipine contraindicated?
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Question 11 of 25
11. Question
A 55-year-old male presents to the emergency department with intermittent palpitations and associated anxiety, which started 3 days ago. He has a medical history of hypertension, major depressive disorder, and Raynaud’s disease, and is currently using lisinopril for hypertension, albuterol and inhaled budesonide for asthma. His lifestyle includes a 10-year history of smoking a pack of cigarettes daily, and drinking four beers on a daily basis. Clinical examination shows a temperature of 98.9°F (37.2°C), blood pressure of 130/85 mmHg, a pulse rate of 135 beats/min, and respiratory rate of 16/min. His pulse is irregular, and end-expiratory scattered wheezes are audible. An EKG test confirms atrial fibrillation. Considering his medical history and present symptoms, which among the following medications would be the most appropriate choice for managing this patient’s atrial fibrillation?
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Question 12 of 25
12. Question
A 48-year-old female patient weighing 70 kg, with a history of Supraventricular Tachycardia (SVT), arrives at the Emergency Department (ED) complaining of chest pains and a rapid heart rate. She is currently not on medication. Her vital statistics show a Blood Pressure of 130/80 mmHg, a Heart Rate of 220 beats per minute, an O2 saturation of 100% on room air, and a Respiratory Rate of 12 breaths per minute. The patient’s last SVT episode occurred two years ago. The attending physician decides to administer adenosine to regulate her heart rate. What is the right initial dose of adenosine to give her?
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Question 13 of 25
13. Question
A 32-year-old man with a known history of palpitations and dizziness presents to the emergency department. Despite his efforts to control these symptoms with deep breaths and neck massages, they have escalated in severity over several hours. His current vital signs indicate a blood pressure of 60/30 mmHg and a heart rate of 220 beats per minute. An EKG reveals regular narrow-complex tachycardia (SVT). Based on his hemodynamic status and current symptoms, what is the most appropriate intervention?
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Question 14 of 25
14. Question
A 75-year-old man presents to the emergency department with palpitations. His medical history includes poorly controlled diabetes and hypertension though he reports being nonadherent to his medications. He is found to be obese, however, his physical exam is otherwise unremarkable. His vital signs are: temperature 98.0°F (36.7°C), blood pressure 122/78 mm Hg, pulse 130 beats/min, respirations 17 breaths/min, and oxygen saturation 98% on room air. An electrocardiogram (ECG) reveals a wide complex ventricular tachycardia (VT). Despite attempts at a vagal maneuver, his rhythm and symptoms persist. What is the most appropriate next step in the management of this patient?
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Question 15 of 25
15. Question
A 65-year-old male with a history of hypertension, managed with amlodipine, presents to the emergency department with shortness of breath and new-onset palpitations lasting two hours. Vital signs are BP 90/62 mm Hg, HR 165 beats/min, RR 26 breaths/min, and temperature 38.9°C. Examination reveals discomfort and bibasilar crackles. ECG shows a narrow complex tachycardia with a regular rhythm, indicating AVNRT. Vagal maneuvers have failed, and the patient refuses adenosine. What is the best initial intervention for this patient?
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Question 16 of 25
16. Question
A 54-year-old man with a history of chronic kidney disease and poorly controlled diabetes mellitus is brought to the emergency room after a syncopal episode. His records indicate he was recently treated for a bacterial respiratory infection with an unspecified antibiotic. At present he is pale, diaphoretic with a weak, rapid pulse and an EKG displays the condition torsades de pointes. A baseline metabolic panel is pending. Which of the following antibiotic regimens could have precipitated his torsades de pointes?
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Question 17 of 25
17. Question
A 55-year-old woman with a past medical history of hypertension controlled with amlodipine is brought to the emergency department via EMS due to acute onset of shortness of breath, altered mental status, and palpitations ongoing for the last 2 hours. Despite her symptoms, she is hemodynamically stable with a BP of 110/62 mm Hg, HR of 165 bpm, RR of 26/min, an O2 saturation of 92% on room air, and temperature of 38.9°C. A 12-lead ECG reveals a wide complex tachycardia with a regular rhythm, the QRS complexes are monomorphic and there is no evidence of a prolonged QT interval. This is suggestive of monomorphic ventricular tachycardia. Base upon her status and condition, what would be the most appropriate initial treatment?
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Question 18 of 25
18. Question
A 53-year-old male with a past medical history of hypertension managed with amlodipine is brought to the emergency department (ED) via emergency medical services (EMS) with elevated palpitations and altered mental status. He’s been feeling unwell for the past few hours, and also experiencing chest discomfort as reported by his wife. His initial vitals are: BP 60/42 mm Hg, HR 165 beats/min, RR 26 breaths/min, and Temperature 38.9°C. A 12-lead ECG reveals a wide complex tachycardia with a regular rhythm without prolonged QT interval, determined as monomorphic ventricular tachycardia. Which intervention should be the initial choice for this patient’s acute management?
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Question 19 of 25
19. Question
A 65-year-old man, known to have hypertension, hyperlipidemia, and coronary artery disease and currently stabilized on lisinopril, atorvastatin, and aspirin, presents to the ED. He has severe shortness of breath, tachypnea, altered mental status, and diaphoresis. His vitals include a blood pressure of 88/54 mm Hg, a respiratory rate of 26 breaths/minute, a heart rate of 53 beats/minute, a pain score of 2/10, and a temperature of 37.8°C. Lab test results are as follows: Na 149 mEq/L, K+ 4.1 mEq/L, Cl 101 mEq/L, HCO3- 22 mEq/L, SCr 1.1 mg/dL (baseline 1.0 mg/dL), BUN 15 mg/dL, and glucose 126 mg/dL. His height is 5’8” and he weighs 150 lb. He is intermittently experiencing bradycardia. Based on his presentation, which is the most appropriate intervention?
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Question 20 of 25
20. Question
A 67-year-old man with a known history of hypertension and diabetes mellitus for which he is receiving metformin and lisinopril, presents to the emergency department with shortness of breath, dizziness, and fatigue that started abruptly an hour ago while watching television. Physical examination reveals clear lungs on auscultation bilaterally, with his vitals being: temperature 37.1°C, blood pressure 97/65 mmHg, pulse 49/min, and respirations 21/min. The patient denies occurrence of chest pain. His EKG shows a Mobitz type 2 second-degree heart block, high-grade block that could progress to a profound heart block causing hemodynamic instability. The initial treatment with atropine was unsuccessful. What is the most appropriate next step in management?
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Question 21 of 25
21. Question
A 65-year-old man presents to the emergency department with symptomatic bradycardia. His blood pressure on admission is 85/43 mmHg. In the past, he has received a heart transplant due to end-stage heart failure. Of the patient’s history provided, which indicates a contraindication to treatment with atropine?
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Question 22 of 25
22. Question
A 68-year-old male patient, with a long-standing battle with congestive heart failure, arrives at the emergency department after experiencing bouts of abnormal weakness and fatigue. Detailed consultation with his cardiologist reveals a recent adjustment to his medication regimen aimed at better hypertension control. His laboratory analysis, conducted three weeks post-medication adjustment, indicates a decline in serum calcium and magnesium levels, both dipping below the standard range. He confirms that furosemide was included in his updated medication regimen. Which segment of the nephron is predominantly impacted by the action of the diuretic administered to this patient?
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Question 23 of 25
23. Question
A 56-year-old man is brought to the emergency department presenting with dyspnea and a mild sensation of chest discomfort. His medical history is significant for coronary artery disease (requiring left anterior descending artery stent and dual antiplatelet therapy, 5 years prior), hypertension, hyperlipidemia, heart failure with reduced ejection fraction, and type II diabetes mellitus. He reports an increase in the number of pillows he needs to sleep comfortably, and notes episodes of paroxysmal nocturnal dyspnea causing him to awaken in the past few nights. His current medications include aspirin, lisinopril, metoprolol succinate, spironolactone, and atorvastatin. His vitals indicate a temperature of 98.6°F, blood pressure of 145/90 mmHg, pulse of 102 per minute, and 20 respirations per minute. Physical examination reveals jugular venous distension, a third heart sound, bilateral crackles in the lung bases, and bilateral mid-thigh pitting edema. Considering the patient’s signs and symptoms, mild chest discomfort, and physical examination findings, what should be the initial step in managing his acute heart failure exacerbation?
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Question 24 of 25
24. Question
A 56-year-old male with a known history of ischemic cardiomyopathy presents to the cardiothoracic team complaining of worsening shortness of breath and orthopnea. Following physical assessment and imaging, he is diagnosed with acute decompensated heart failure (ADHF). The patient is initiated on nesiritide therapy due to severe pulmonary congestion. When considering endogenous natriuretic peptide physiology, which of the following physiological conditions instigate the release of the endogenous human analogue of nesiritide?
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Question 25 of 25
25. Question
A 63-year-old man, with a medical history of hypertension and hyperlipidemia, rushes to the emergency room complaining of severe centralized chest pain that started 20 minutes ago, radiating to his left arm. The pain is described as crushing in nature. On examination, the patient is noted to be in discomfort, sweating profusely and his pulse is rapid. An electrocardiogram reveals ST segment elevations in the V3-V5 leads, an indication of a myocardial infarction. The patient is promptly administered sublingual nitroglycerin, which appears to alleviate his pain significantly.
What is the primary mechanism of action exhibited by nitroglycerin in this scenario?
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