Pharm final2

ND, a 56-year-old woman who smokes two packs of cigarettes per day, is admitted to the emergency department with severe left-sided chest pain and numbness down her left arm. She is diagnosed with acute coronary syndrome, is admitted, and undergoes percutaneous transluminal coronary angioplasty of her left main coronary artery. Her lipid profile was obtained in the emergency department and reveals the following: total cholesterol 229 mg/dL (5.92 mmol/L), HDL cholesterol 48 mg/dL (1.24 mmol/L), and triglycerides 147 mg/dL (1.66 mmol/L). The cardiologist who performed ND's angioplasty would like to start her on lipid-lowering therapy. What would be the most appropriate therapy?

Atorvastatin 80 mg daily

PD is a 39-year-old Hispanic man with hypertension, type 1 diabetes mellitus, and chronic kidney disease (CKD; serum creatinine 1.8 mg/dL [159 ?mol/L], estimated creatinine clearance 40 mL/min [0.67 mL/s]) with mild proteinuria. You are starting him on an angiotensin-converting enzyme inhibitor today. What is the most appropriate time frame for laboratory follow-up?

1 to 2 weeks

ND, a 56-year-old woman who smokes two packs of cigarettes per day, is admitted to the emergency department with severe left-sided chest pain and numbness down her left arm. She is diagnosed with acute coronary syndrome, is admitted, and undergoes percutaneous transluminal coronary angioplasty of her left main coronary artery. Her lipid profile was obtained in the emergency department and reveals the following: total cholesterol 229 mg/dL (5.92 mmol/L), HDL cholesterol 48 mg/dL (1.24 mmol/L), and triglycerides 147 mg/dL (1.66 mmol/L). What is her LDL cholesterol?

152 mg/dL (3.93 mmol/L) LDL cholesterol (mg/dL) = total cholesterol − (HDL cholesterol + triglycerides/5) using traditional units of mg/dL

Decreasing the dose of an inhaled corticosteroid may be feasible after a patient's asthma has been controlled for:

3 months

Which of the following GAD patients is most likely to be a CYP 2C19 poor metabolizer and will have an exaggerated response to diazepam 5 mg three times daily with increased sedation and CNS and cognitive side effects?

45-year-old Asian man

If a patient has experienced more than three episodes of depression in his or her lifetime, what is the likelihood of having another episode of depression?

90%

AJ is a 52-year-old male admitted to the hospital with suspected aspiration pneumonia. His home medications are lisinopril 20 mg once daily and omeprazole 20 mg once daily. What organisms need to be considered as causative agents in AJ?

Anaerobes, E. coli, and viridans Streptococci

Which of the following is an appropriate educational point about the technique of taking blood pressure to ensure an accurate reading?

Arm must be supported and at heart level

TJ is a 49 year-old woman who separated from her husband of 25 years 3 weeks ago. Before the separation, TJ discovered her husband was having an affair with her best friend. Since receiving news of the affair, TJ has gained 12 pounds (5.5 kg) and finds it difficult to get to work on time in the morning because she wishes to stay in bed and sleep. She is having difficulty concentrating at work and getting anything completed, and she does not feel like exercising or singing in the church choir as she did in the past. Based on the signs and symptoms, the type of depression TJ most likely has is:

Atypical depression

BH is a 67-year-old African American man who has resistant hypertension. Past medical history is also significant for heart failure with left ventricular systolic dysfunction, dyslipidemia, and peripheral vascular disease. Medications currently include lisinopril, carvedilol, and furosemide. Current blood pressure is 146/88 mm Hg, and when repeated it is 148/82 mm Hg. Which of the following additions to his medication regimen would not be an appropriate choice at this time?

Minoxidil

Which medication is not associated with causing elevations in blood pressure?

Morphine

PF is a 50-year-old male who smokes two packs of cigarettes per day. Which of the following host defenses that protect the lung are known to be impaired by the smoke

Mucous and ciliated cells

SR is a 59-year-old Asian American woman with a 3-year history of T2DM. She presents with no new complaints today. Her laboratory study test results and vital signs are A1c, 8.1% (0.081; 65 mmol/mol Hb); FBG, 320 mg/dL (17.8 mmol/L); LDL, 118 mg/dL (3.05 mmol/L); HDL, 32 mg/dL (0.83 mmol/L); TG, 325 mg/dL (3.67 mmol/L); SCr, 0.9 mg/dL (80 µmol/L); BP, 128/78 mm Hg; HR, 68 beats/min; wt, 135 lb (61.4 kg); and ht: 5'2" (157 cm). Her current medications are: Glimepiride 2 mg once daily Metformin 1000 mg twice daily Nateglinide 60 mg three times daily Sitagliptin 100 mg/day Alendronate 70 mg/wk Simvastatin 20 mg once daily Paroxetine 20 mg once daily Aspirin 81 mg once daily Which of her medications should be discontinued and for what reason?

Nateglinide because of therapeutic duplication

TM is a 26-year-old woman who is diagnosed with panic disorder. Her only other significant medical condition is that she was diagnosed with irritable bowel syndrome 1 year ago. The doctor would like to start TM on Paxil (paroxetine) 40 mg by mouth every morning. Is this an appropriate starting dose?

No, this is an inappropriate starting dose.

CW, a 46-year-old man, presents for his annual physical examination. He states that he has been going to the bathroom more frequently than normal and has lost approximately 20 lb (9.1 kg) in the past 6 months without trying. His random glucose test result today is 252 mg/dL (14.0 mmol/L). Which of the following is most appropriate to confirm diagnosis of type 2 diabetes?

Nothing; there is enough information available to diagnose CW with type 2 diabetes.

Components of the recommended strategy for the diagnosis of ventilator-associated pneumonia include:

Obtaining either a quantitative or semiquantitative culture of a lower respiratory sample On days 2 and 3: check culture results and assess clinical response to therapy. If the clinical assessment at day 2 or 3 is improvement in the patient and the cultures are negative, then antibiotics should be stopped.

When treating a patient with panic disorder, which responds or improves first?

Panic attacks

A 23-year-old married white woman comes to the outpatient psychiatric clinic complaining of decreased sleep, decreased appetite, decreased concentration, depressed mood, thoughts of death, and lack of interest in activities for 6 weeks' duration. She has no history of psychiatric illness and takes no medications except for Ortho-Tri-Cyclen Lo daily. She is diagnosed with major depressive disorder. Which of the following medications would be the BEST initial option for treating this patient?

Paroxetine 20 mg po daily

Which of the following statements regarding panic disorder is true?

Patients frequently present to the emergency department because of fear of having an MI.

On which patients would you perform a Framingham risk assessment?

Patients with two or more major CHD risk factors

DG is a 55-year-old white man with seated office blood pressure (BP) readings of 142/70 mm Hg and 138/72 mm Hg. He is asked to return in 2 weeks for repeat measurements, which are 138/68 mm Hg and 134/71 mm Hg. Which of the following classifies DG's BP per the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure?

Prehypertension

CD is a 66-year-old female admitted to the hospital for respiratory failure. Upon admission she was intubated. She was improving and on day 9 was starting to be weaned off the ventilator. On day 9 her respiratory symptoms were worsening and full ventilator settings were required. She is diagnosed with ventilator-associated pneumonia. Which of the following organisms are most likely associated with her pneumonia?

Pseudomonas aeruginosa, Acinetobacter spp., and MRSA

JT is a 36-year-old white woman. She is concerned about her risks for developing type 2 diabetes because her mother and father have the disease. Currently, she weighs 145 lb (66 kg; BMI = 22 kg/m2) and has no other medical conditions. All of her children weighed less than 8 lb (3.6 kg) at birth, and she is preparing for her second marathon. Which of the following is the most appropriate recommendation regarding screening for type 2 diabetes in this patient?

Recommend screening at the age of 45 years and then every 3 years if normal.

MJ is an obese 69-year-old African American man recently diagnosed with stage 1 primary hypertension. He does not like to cook and therefore prefers to eat out for his meals. States that he smokes 1 pack of cigarettes per day but denies any alcohol consumption. Which of the following is an appropriate nonpharmacologic treatment recommendation for this patient to help improve his hypertension?

Reduce sodium intake to approximately 2.4 g/day

Which of the following treatments is most appropriate for a hypertensive emergency?

Reduction in mean arterial pressure up to 25% within minutes to hours

Proper use of inhaled corticosteroids includes:

Rinsing the mouth after each use

AJ. is a 23 year old otherwise healthy female with GAD. She has no past history of drug or alcohol abuse and no family history of substance abuse. She is started on lorazepam 0.5 mg three times daily. Which of the following side effects will you warn F.M. about?

Risk of withdrawal symptoms upon discontinuation Sedation Anterograde amnesia Slowed reaction time

DR is a 72-year-old male who presented to the hospital for a hernia repair. PMH is significant for smoking for the last 20 years. He has been intubated for the last 2 days, and attempts to wean DR off of the ventilator failed. The nurses noted increased volume and purulence of secretions from the ventilator. Chest x-ray: left lower lobe infiltrate. Urinary DFA for Legionella is negative. Ht: 5'10" (178 cm) Wt: 75 kg and he has NKDA. PMH is negative, and home medications are 1 multivitamin once daily. Creatinine clearance is 70 mL/min (1.17 mL/s), WBCs are 13.5 cells/mm3 (13.5 ? 106/L), and temperature is 100.4oF (38.0 oC). Which of the following organisms are the most likely pathogens for DR's pneumonia?

S. pneumoniae, MSSA, E. coli, K. pneumoniae

A 38 year-old man status post MI who is a nonsmoker returns to clinic with the following lipid panel: total cholesterol 168 mg/dL (4.34 mmol/L); triglycerides 148 mg/dL (1.67 mmol/L); HDL cholesterol 43 mg/dL (1.11 mmol/L); LDL cholesterol 95 mg/dL (2.46 mmol/L). He is currently taking pitavastatin 4 mg. What other interventions would you implement in this case?

Screen his children for high cholesterol

A 36-year-old man is admitted to the hospital for a severe methicillin-resistant Staphylococcus aureus diabetic foot infection and is started on linezolid 600 mg IV q12 hours. His medication profile includes paroxetine 40 mg every morning, trazodone 100 mg at bedtime as needed for sleep, and metformin 1000 mg po bid. After 3 days on these medications, the patient becomes agitated, confused, and diaphoretic and develops myoclonic jerks. Which of the following is his most likely diagnosis?

Serotonin syndrome

AS is a 26-year-old African American male with SAD who has been stable on sertraline 100 mg/day for the past year. He reports to the clinic today with complaints of increased anxiety, agitation, and nausea. Upon further examination, you notice he last filled his sertraline Rx (90-day supply) 4 months ago. Medications: Ibuprofen 400 mg as needed for joint pain. He reports taking sertraline most days but ran out 4 days ago. What is most likely going on with AS?

Serotonin withdrawl

What is the best treatment for a 34-year-old black woman with comorbid panic disorder and major depressive disorder?

Sertraline

A 52-year-old woman with hypertension (145/92 mm Hg) and a HDL cholesterol of 34 mg/dL (0.88 mmol/L) presents to your clinic today. She has no family history of premature CHD. She is overweight, does not exercise, and her diet is high in carbohydrates. The patient is otherwise healthy and does not smoke. Her lipid panel today is total cholesterol 172 mg/dL (4.45 mmol/L) and triglycerides 690 mg/dL (7.80 mmol/L). What is your assessment of this patient's lipid disorder?

She has hypertriglyceridemia

A 52-year-old woman with hypertension (145/92 mm Hg) and a HDL cholesterol of 34 mg/dL (0.88 mmol/L) presents to your clinic today. She has no family history of premature CHD. She is overweight, does not exercise, and her diet is high in carbohydrates. The patient is otherwise healthy and does not smoke. Her lipid panel today is total cholesterol 172 mg/dL (4.45 mmol/L) and triglycerides 690 mg/dL (7.80 mmol/L). What intervention would be most appropriate for this patient?

Start prescription omega-3 fatty acid esters 4 g daily

A 46-year-old woman presents to the psychiatric outpatient clinic for follow-up treatment of major depression. She is currently on paroxetine 10 mg at bedtime, which she started taking 2 months ago when admitted to the psychiatric hospital for suicidal ideation. During the interview, she says that she does not think the medication is working because she is just as depressed as she was before taking the medication and has recently started drinking eight to 10 beers daily to alleviate the depression. Before this episode, she was sober for 4 years. Which of the following treatment strategies would be the appropriate choice for this patient?

Stop the paroxetine and start duloxetine 20 mg/day.

Which of the following causes the greatest risk of mortality in patients with depression?

Suicide

Oral glucose lowering agents that primarily stimulate insulin secretion and cause hypoglycemia are classified as:

Sulfonylureas

Niacin is associated with flushing, itching, and liver toxicity. Sustained-release niacin is associated with a higher incidence of liver toxicity compared with IR niacin preparations. Choose the best answer that explains the difference in liver toxicity between the two preparations.

Sustained-release preparations have a slow absorption rate allowing more niacin to be metabolized by the amidation pathway

A 52-year-old woman with hypertension (145/92 mm Hg) and a HDL cholesterol of 34 mg/dL (0.88 mmol/L) presents to your clinic today. She has no family history of premature CHD. She is overweight, does not exercise, and her diet is high in carbohydrates. The patient is otherwise healthy and does not smoke. Her lipid panel today is total cholesterol 172 mg/dL (4.45 mmol/L) and triglycerides 690 mg/dL (7.80 mmol/L). What is this patient's primary target for intervention?

Triglycerides

A 52-year-old woman with hypertension (145/92 mm Hg) and a HDL cholesterol of 34 mg/dL (0.88 mmol/L) presents to your clinic today. She has no family history of premature CHD. She is overweight, does not exercise, and her diet is high in carbohydrates. The patient is otherwise healthy and does not smoke. Her lipid panel today is total cholesterol 172 mg/dL (4.45 mmol/L) and triglycerides 690 mg/dL (7.80 mmol/L). What is her LDL cholesterol?

Unable to calculate

Which initial antidepressant regimen is likely to be the best tolerated by a patient with panic disorder?

Venlafaxine 37.5 XR daily

JT is a 45-year-old African American man with primary hypertension with an average BP of 152/90 mm Hg and heart rate of 70 bpm after 3 months of lifestyle modifications. His medical history is significant for irritable bowel syndrome with chronic persistent diarrhea leading to several hospitalizations for dehydration and metabolic disturbances (i.e., hypokalemia). Which of the following antihypertensives would be most appropriate at this time?

Verapamil

Which one of the following medications requires liver function monitoring?

Zileuton

Which of the following symptoms is most likely to improve within the first week or so of SSRI treatment?

sleep

Which lipoprotein particle is not considered to be atherosclerotic?

HDL

A 38 year-old man status post MI who is a nonsmoker returns to clinic with the following lipid panel: total cholesterol 168 mg/dL (4.34 mmol/L); triglycerides 148 mg/dL (1.67 mmol/L); HDL cholesterol 43 mg/dL (1.11 mmol/L); LDL cholesterol 95 mg/dL (2.46 mmol/L). He is currently taking pitavastatin 4 mg. What change in therapy would be most consistent with the above?

Add ezetimibe 10 mg daily

A patient diagnosed with metabolic syndrome and CHD is taking atorvastatin 20 mg, and his LDL cholesterol is 78 mg/dL (2.02 mmol/L). His primary care physician has tried to increase him to 40 mg; however, the patient complains of muscle pain and weakness shortly after the dose is escalated. His triglycerides are currently 198 mg/dL (2.24 mmol/L), HDL cholesterol is 39 mg/dL (1.01 mmol/L), and total cholesterol is 157 mg/dL (4.06 mmol/L). What would be the most appropriate intervention?

Add ezetimibe 10 mg daily

Which one of the following medications is used to treat an acute asthma exacerbation?

Albuterol

Which of the following uncontrolled disease states may worsen asthma control?

Allergic rhinitis

What anatomical area of the brain is a major mediator in our response to stress?

Amygdala

Which medication is most likely to cause bronchoconstriction in an asthma patient?

Carvedilol

Dosing for omalizumab is based on which of the following criteria?

Baseline IgE levels

MG is a 32-year-old Hispanic American man who is a newly diagnosed type 2 diabetes patient (3 months; drug naïve). His A1c is 8.5% (0.085; 69 mmol/mol Hb). He is an overweight high-rise construction worker and does not like needles. Which pharmacotherapy treatment option would you recommend?

Biguanide

During pregnancy, which of the following medications is preferred as the long-term control medication?

Budesonide

A 25-year-old man with major depression is discussing the potential risks and benefits of various antidepressants, and he notes that he will not take any medication that decreases his libido or interferes with him obtaining or maintaining an erection. Which of the following medications would be most appropriate for this patient?

Bupropion

Which of the following agents has the unique mechanism of action of being a DA and NE reuptake inhibitor?

Bupropion

A 26-year-old man with a history of depression has been taking sertraline 200 mg/day for 12 weeks with no response. The patient has no other complications. The physician asks for your recommendation. The most reasonable recommendation would be to:

Change to venlafaxine

JJ is a 13-year-old girl with GAD. What is the preferred first-line intervention?

Cognitive-behavioral therapy

Before an empirical regimen can be selected, which of the following must be evaluated?

Comorbid conditions that the patient has that could influence the regimen or outcomes

Which of the following statements regarding resistance issues associated with Streptococcus pneumoniae is false?

Macrolide/azalide resistance rates correlate closely with clinical failure rates

The patient returns to clinic after 3 months for follow-up with the following lipid panel: total cholesterol 234 mg/dL (6.05 mmol/L); triglycerides 250 mg/dL (2.83 mmol/L); HDL cholesterol 39 mg/dL (1.01 mmol/L); LDL cholesterol 145 mg/dL (3.75 mmol/L). What change in therapy would be most appropriate? *

Continue TLC but also reduce saturated fats and cholesterol and encourage to continue weight loss

Which one of the following statements about corticosteroid use during an asthma exacerbation is true?

Corticosteroids may be initiated in the home setting

A 67-year-old Asian man with a recent myocardial infarction has an average BP of 148/86 mm Hg and a pulse of 76 bpm. Which of the following antihypertensive agents is preferred in this setting?

Metoprolol tartrate

GH is a 58-year-old female who presents to the emergency room complaining of a productive cough (greenish/yellowish stuff) and chest tightness. She states this feels different from her usual cough. Two weeks earlier, she had developed a cold, which was resolving prior to the onset of the current symptoms. For the last week she babysat her 2-year-old grandson who had an ear infection and could not attend his daycare. PMH: COPD ? 6 yrs Allergies: cephalosporins—hives, shortness of breath SH: smoked 2-ppd ? 10 years, quit 2 years ago, lives with her husband (nonsmoker) Vitals: 100.8 °F (38.2 °C), HR 80, 118/86 Pulse Ox: 82% (0.82) on room air PE: Lungs: rales, rhonchi, decreased breath sounds over right mid lobe Chest x-ray: right mid lobe infiltrate Sputum Gram stain: Moderate WBCs, no organisms seen What signs, symptoms, and risk factors does GH have that are associated with community-acquired pneumonia?

Cough, rales, rhonchi, decreased breath sounds, low oxygenation, chest tightness, fever, chest x-ray findings, exposure to grandson

Which of the following does not describe an epidemiologic issue with community-acquired pneumonia?

CAP caused by CA-MRSA is often a necrotizing disease only in elderly patients.

Which of the following is (are) clinically important properties of B-blockers?

Cardioselectivity

Which of the following is not true of a patient with social anxiety disorder?

Fear is rational

Which type of therapy would be most appropriate for a 58-year-old woman with type 2 diabetes and total cholesterol 210 mg/dL (5.43 mmol/L), HDL cholesterol 52 mg/dL (1.34 mmol/L), triglycerides 958 mg/dL (10.83 mmol/L), and LDL cholesterol 131 mg/dL (3.39 mmol/L)?

Fenofibrate 160 mg daily

A friend just found out that she is 4 weeks into her pregnancy. She has a history of major depressive episodes and asks you if any of the antidepressants are safe to take during pregnancy. Which one of the following do you tell her is considered among the first-line treatments?

Fluoxetine

Which of the following SSRIs requires up to a 5-week washout period because of the long half-life of its potent active metabolite?

Fluoxetine

Of the following combinations of medications, which one would you most want to avoid?

Fluoxetine-phenelzine

Which of the following may increase blood glucose levels by impairing the action of insulin?

Glucocorticoids

What is the A1c-lowering potential of Insulin?

Greater than 2.5% (0.025; 27 mmol/mol Hb)

High-dose albuterol therapy may cause:

Decreased duration of action of albuterol

Pregabalin is a preferred treatment for a patient with GAD and a history of which of the following?

Did not tolerate SSRIs

AL is a 29-year-old black woman who presents to your clinic with a BP of 160/94 mm Hg. Repeat readings over the next 2 weeks average 156/92 mm Hg. The patient has no past medical history with the exception of Crohn's disease, which is currently treated with chronic steroid therapy. She is also taking an oral contraceptive. Physical examination and laboratory tests are unremarkable. Appropriate interventions at this time include:

Discontinuation of the oral contraceptive to rule out drug-induced hypertension; Reassessment of the dose and need for long-term oral steroids

A patient comes to your pharmacy with a bag of prescriptions. Inside is a bottle of paroxetine, propranolol, acetaminophen, and ranitidine. He complains of nausea, insomnia, muscle aches, anxiety, and dizziness. Choose which side effect he is most likely experiencing.

Discontinuation syndrome

KP is a 36-year-old woman with stage 1 hypertension for the past 2 years that has been well controlled (BP range: 100-110/60-65 mm Hg) on lisinopril, 5 mg once daily. She has successfully implemented lifestyle modifications, losing 14 kg (30 lb) and obtaining a body mass index of 21 kg/m2. She informs you she is going to start trying to get pregnant. What changes should be instituted with her antihypertensive therapy at this time?

Discontinuing lisinopril and monitoring BP closely with lifestyle modifications

Which of the following drug classes would a patient with a low plasma renin activity (less than 0.65 ng/mL/h [0.18 ng/L/s]) most likely have the best blood pressure lowering response to?

Diuretics

Nonpharmacologic treatments for a patient with asthma and dust mite sensitivity includes which one of the following?

Encasing pillows and mattress with allergen covers

AZ is a 69-year-old white woman with HTN, CHF, COPD, and recently diagnosed GAD. Which of the following medications is the best choice for management of her GAD?

Escitalopram

Which of the following medications has a common adverse effect of nausea?

Exenatide

Which of the following is true regarding noninsulin injectable therapy for treatment of diabetes?

Exenatide lowers glucose levels by several mechanisms, including regulating gastric emptying.

Monitoring of inhaled corticosteroids includes which of the following:

Height

Which of the following is not a secondary cause of dyslipidemia?

Hyperthyroidism

Which statement is true concerning dipeptidyl peptidase-4 (DPP-4) inhibitors?

Hypoglycemia is not a common adverse effect.

Which of the following medications may cause an asthma exacerbation in some patients with severe asthma?

Ibuprofen, aspirin, ketorolac

Which of the following statements regarding nonpharmacologic therapy for treatment of diabetes is true?

Individualized meal plans should be developed for people with diabetes based on cultural preferences, comorbidities, and daily schedule as much as possible.

What type of medication is required to be used with long-acting ß2-agonists (LABAs)?

Inhaled corticosteroids

TR, a 57-year-old man, has had type 2 diabetes for approximately 15 years. His physician is initiating insulin therapy today because of his elevated A1c despite oral therapy. Which of the following is the most appropriate option for TR?

Initiate insulin glargine 10 units every night at bedtime.

Which of the following is true of CBT in the treatment of anxiety?

Is associated with more sustainable benefits than antidepressants

Which of the following statements is true regarding quetiapine in the treatment of anxiety disorders?

Is associated with weight gain, sedation, and fatigue

DT is a 77-year-old white woman diagnosed with heart failure with left ventricular systolic dysfunction. She has a history of hypertension, osteopenia, coronary artery disease, and melanoma. According to the American Heart Association, consideration should be given to targeting a blood pressure goal of:

Less than 120/80 mm Hg

VS is a 67-year-old white woman who has been recently diagnosed with type 2 diabetes. Her past medical history is significant for hypertension, hyperlipidemia, and hypothyroidism. Her current medications include hydrochlorothiazide, levothyroxine, and simvastatin. At diagnosis, her vital signs and laboratory study test results were as follows: BP, 157/94 mm Hg; weight, 157 lb (71 kg; body mass index, 24 kg/m2); A1c, 8.7% (0.087; 72 mmol/mol Hb); fasting plasma glucose, 174 mg/dL (9.7 mmol/L); LDL, 52 mg/dL (1.34 mmol/L); HDL, 59 mg/dL (1.53 mmol/L); and triglycerides, 45 mg/dL (0.51 mmol/L). What is VS's goal blood pressure according to current treatment guidelines?

Less than 130/80 mm Hg

JF is a 60-year-old female presents to the emergency room complaining of a productive cough (greenish/yellowish stuff) and chest tightness. PMH: IDDM ?10 years, HTN ? 4 years. Vitals: 101.2oF (38.4 °C), HR 80, 118/86, respiratory rate 18,pulse oximetry (oxygen saturation) 96% (0.94) on room air. Ht. 5'5" (165 cm) Wt. 140 lbs (63.6 kg). Allergies: cephalosporins—hives. Home medications are insulin and atenolol 50 mg qd. Chest x-ray: right mid lobe infiltrate. Her electrocardiogram is normal, renal function is normal (creatinine clearance 75 mL/min [1.25 mL/s]), and WBCs are 11.8 cells/mm3 (11.8 ? 106/L). 9. Which of the following would be the most appropriate empirical therapy for JF's pneumonia?

Levofloxacin 750 mg PO every 24 hours

VS is a 67-year-old white woman who has been recently diagnosed with type 2 diabetes. Her past medical history is significant for hypertension, hyperlipidemia, and hypothyroidism. Her current medications include hydrochlorothiazide, levothyroxine, and simvastatin. At diagnosis, her vital signs and laboratory study test results were as follows: BP, 157/94 mm Hg; weight, 157 lb (71 kg; body mass index, 24 kg/m2); A1c, 8.7% (0.087; 72 mmol/mol Hb); fasting plasma glucose, 174 mg/dL (9.7 mmol/L); LDL, 52 mg/dL (1.34 mmol/L); HDL, 59 mg/dL (1.53 mmol/L); and triglycerides, 45 mg/dL (0.51 mmol/L). Which of the following is the most appropriate recommendation for therapy according to the ADA algorithm?

Lifestyle changes and metformin

RB is a 52-year-old Asian man who was recently diagnosed with primary hypertension. His comorbidities include diabetes and dyslipidemia. His last two blood pressure readings were 138/94 mm Hg and 144/86 mm Hg. A recent urinalysis revealed proteinuria. Which of the following antihypertensives would be most appropriate for this patient?

Lisinopril

VS is a 67-year-old white woman who has been recently diagnosed with type 2 diabetes. Her past medical history is significant for hypertension, hyperlipidemia, and hypothyroidism. Her current medications include hydrochlorothiazide, levothyroxine, and simvastatin. At diagnosis, her vital signs and laboratory study test results were as follows: BP, 157/94 mm Hg; weight, 157 lb (71 kg; body mass index, 24 kg/m2); A1c, 8.7% (0.087; 72 mmol/mol Hb); fasting plasma glucose, 174 mg/dL (9.7 mmol/L); LDL, 52 mg/dL (1.34 mmol/L); HDL, 59 mg/dL (1.53 mmol/L); and triglycerides, 45 mg/dL (0.51 mmol/L). What is the most appropriate medication to add to VS's regimen to control her hypertension?

Lisinopril

Which of the following is a dangerous combination?

MAOI-meperidine

The most effective albuterol delivery method for a typical 6-year-old child is:

MDI with valved-holding chamber