PHA 591 Disease State Capstone

HBP Therapy

Ace-I ARB's CCB Diuretics

What are the first-line therapies for heart failure that improves morbidity and mortality?

Ace-I ARNI ARB's Beta-blockers

While discharging a patient, provider gave patient zofran 4mg q4-6 h once daily, what are the IESA components?

Adherence-more cost-effective medication available

A patient comes to the pharmacy and states that they are considering quitting smoking. The patient has a smoking history of 1 pack of cigarettes per day. You assess the patient's readiness to quit smoking using the 5As. Which of the following is NOT a component of the 5 A's?

Administer

Which of the following is NOT considered a complication of diabetes?

Angioedema

Rare but serious side effects of Lisinopril

Angioedema birth defects liver failure

According to ACC/AHA guidelines, which of the following is a first-line treatment option for hypertension?

Angiotensin-converting enzyme inhibitor

_______________ should be interrupted 24-48 h prior to dental and surgical procedures and re-started after hemostasis. Avoid OTC NSAIDs and high-dose aspirin; they increase the risk of bleeding.

Apixaban and Edoxaban

List 5 A's for smoking cessation

Ask Advise Assess Assist Arrange

Moderate intensity statins

Atorvastatin 10-20mg Rosuvastatin 5-10mg Simvastatin 20-40mg Pravastatin 40-80mg Lovastatin 40mg Fluvastatin XL 80mg Fluvastatin 40mg BID Pitavastatin 2-4mg

High intensity statins

Atorvastatin 40-80 mg Rosuvastatin 20-40 mg

Which of the following is the mechanism of action of dulaglutide?

Binds to glucagon-like peptide 1 receptors, slowing gastric emptying and increases insulin secretion by pancreatic beta cells

MOA apixaban

By selectively inhibits factor Xa, apixaban decreases thrombin generation and thrombus development.

Which of the following are questions a RPH should consider when assessing the "indication" of a patient medication therapy?

Does the patient have an indication for the medication? Does the patient have an untreated medical condition that requires therapy, but its not being treated or prevented?

When initiating deprescribing in an older adult, it is best to discontinue all medications at the same time and slowly reintroduce medications to address symptoms of the disease. True or False

False

List the components of "IESA" as a framework for medication assessment.

Indication Effectiveness Safety Assessment

Which one of the following is the mechanism of action for warfarin?

Inhibits coagulation by inhibiting the formation of clotting factors in the liver that require vitamin K to form

Which of the following are questions a RPH should consider when assessing the "effectiveness" of a patient medication therapy?

Is the patient meeting the clinical goals of therapy? Do additional labs need to be obtained to monitor the effectiveness of the medication therapy?

Which of the following is/are question(s) a pharmacist should consider when assessing the "adherence" of a patient's medication therapy?

Is the patient receiving the most affordable option to optimize adherence? Are the medications taken at times during the day that are convenient for the patient? Is the patient taking the medications as prescribed/instructed or missing doses? Is the frequency and formulation appropriate for the patient to optimize adherence?

It works primarily by lowering glucose production in the liver and improving your body's sensitivity to insulin so that your body uses insulin more effectively.

Metformin

What OTC impact blood pressure?

NSAIDS Aspirin

Which of the following are true about the mechanism of action for an Angiotensin-Converting Enzyme Inhibitor (ACE-I)?

Prevents the conversion of angiotensin I to angiotensin II Disrupts the renin-angiotensin-aldosterone system and leads to vasodilation, sodium excretion, and potassium reabsorption

Which of the following are true about the mechanism of action for an Angiotensin-Converting Enzyme Inhibitor (ACE-I)?

Prevents the conversion of angiotensin I to angiotensin II Disrupts the renin-angiotensin-aldosterone system and leads to vasodilation, sodium excretion, and potassium reabsorption

Which of the following is the mechanism of action of Metformin?

Reduces hepatic glucose production and enhances glucose utilization by muscle

Which of the following is a high intensity statin?

Rosuvastatin 20 mg

Your working as an inpatient RPH and overhear a conversation between 2 HCP. The nurse told the provider that the patient is sniffing a lot, the provider will give Benadryl IV. What are the components of IESA that you should be concerned with at this time?

Safety-risk of adverse effects Effectiveness-more effective medication available

List the signs and symptoms of hypoglycemia.

Tachycardia shaking sweating nervous/anxiety irritated/confused dizzy hunger

Anticoagulants work by interrupting the process involved in the formation of blood clots.

They're sometimes called "blood-thinning" medicines, although they don't actually make the blood thinner.

Ace-I prevents an enzyme in the body from producing angiotensin II, a substance that narrows blood vessels.

This narrowing can cause high blood pressure and forces the heart to work harder. Angiotensin II also releases hormones that raise blood pressure.

New-onset hypertension or exacerbation of hypertension may occur with NSAID use. True or False

True

HF is a 61-year-old female with a past medical history of uncontrolled hypertension and arthritis comes into the pharmacy for an OTC recommendation for pain. The patient takes Naproxen 500mg tablets for her arthritis pain but reports some relief in symptoms. As the pharmacist, you are concerned with the patient's chronic use of NSAIDs due to her blood pressure being uncontrolled. Which of the following would be an appropriate OTC recommendation for arthritis pain?

Tylenol

What Factor XA inhibitor drugs have common side effect of bleeding?

Xarelto Eliquis Savaysa

Prescribing cascade

a new medical condition that leads to prescribing of additional medications

amlodipine less common side effects

abdominal pain arthralgia constipation dizzy fatigue flushing H/A hypotension hyperkalemia impotence myalgia nausea palpitations pruritis rash tachycardia urticaria

Simvastatin less common side effects

abdominal pain constipation diarrhea headache increased liver enzymes myalgia nausea rash

Medications that risk for falls

anticonvulsants BZD antidepressants opioids antipsychotics sedatives anticholinergics antihistamines OTC, herbals, etc

Glipizide common side effects

asthenia *weak, lack of energy

HCTZ rare side effects

cardiac arrhythmias hepatitis pancreatitis steven-johnson-syndrome

MOA lisinopril

competitive ACE-I. It also reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein-kinin system, and can alter prostanoid metabolism, inhibit the sympathetic nervous system, and inhibit the tissue renin-angiotensin system.

MOA atorvastatin

competitively inhibit the conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis.

HCTZ less common side effects

constipation hypercalcemia hyperglycemia hyperuricemia hypokalemia hypomagnesemia hyponatremia impotence loss of appetite nausea photosensitivity rash

Which is not a fall risk factor?

cost

Glipizide rare side effects

cutaneous hypersensitivity hemolytic anemia hepatotoxicity disulfiram reaction

The planned and supervised process of dose reduction or stopping medications that may no longer be of benefit or maybe causing harm, describes which of the following?

deprescribing

What is the planned and supervised process of dose reduction or stopping medications that may no longer be of benefit or may be causing harm?

deprescribing

metoprolol common side effects

dizzy fatigue hypotension

Less Common Adverse Effects of Lisinopril

dry cough dizzy diarrhea headache hypotension hyperkalemia rash tachycardia vomiting

Pradexa/Dabigatran common side effects are:

dyspepsia gastritis less common *bleeding *GERD

HCTZ increases sodium and chloride __________.

excretion

Glucotrol

glipizide

amlodipine rare side effects

hepatotoxicity thrombocytopenia AMI angina

Beta-blockers are not recommended as first-line therapy

https://www.cdc.gov/globalhealth/healthprotection/ncd/training/files/Session3_ParticipantGuide.pdf

Glipizide less common side effects

hypoglycemia, headache nausea, tremor constipation diarrhea, dizziness nervousness

HCTZ common side effects

hypotension dizzy headache

MOA HCTZ

increase sodium and chloride excretion by interfering with their reabsorption in the cortical diluting segment of the nephron.

Which of the following is a potential side effect of pravastatin?

increased ALT/AST myopathy

MOA tirzepatide *dual agonist

is a glucose-dependent insulinotropic polypeptide (GIP) receptor and glucagon-like peptide-1 (GLP-1) receptor agonist that increases glucose-dependent insulin secretion, decreases inappropriate glucagon secretion, and slows gastric emptying.

T2DM first-line therapy

metformin *except when crcl <30 SGLT2i GLP-1

Polypharmacy is when __________ medications are used than needed, despite the number.

more

Metformin reduces hepatic glucose production and enhances glucose utilization by ____________.

muscle

Can I dose warfarin with a factor Xa inhibitor?

no

The patient loss her balance when she was pushed over at the store. How would you best describe her fall? a. a fall b. a near fall c. a geriatric syndrome d. none

none

Factors that put a patient at risk of falls

old age female previous falls muscle weakness gait and balance problems poor vision postural hypotension fear of falling chronic health conditions *and many more

amlodipine common side effects

peripheral edema pulmonary edema

80-year female unsteady while walking, but has not fell

positive risk for fall

Polypharmacy risk factors

prescribing cascade multiple chronic disease wellness/preventative care care transitions

MOA warfarin

prevents the conversion of vitamin K back to its active form from vitamin K epoxide. This impairs the formation of the vitamin K-dependent clotting factors II, VII, IX, and X (prothrombin) and proteins C and S (physiologic anticoagulants).

patient has a TUG score of 18 sec with increased trunk sway

refer to physical therapist

Simvastatin rare side effects

rhabdomyolysis myopathy hepatotoxicity tendon rupture elevated HgA1c immune-mediated necrotizing myopathy

INR above 3 increase the ________

risk of bleed

INR below 2 increases the ___________

risk of blood clot

Prescribing cascade is a medication that is prescribed to treat the _________________ of another medication.

side effects

Which of the following is a symptom of hypoglycemia?

sweating

Which of the following is/are a risk factor for the development of polypharmacy?

transition of care multiple chronic diseases wellness/preventive care the prescribing cascade

Identify treatment for VTE and describe monitoring parameters

*anticoagulant therapy rivaroxaban dabigatran apixaban edoxaban

Identify the five steps associated with PPCP

-collect -assess -plan -implement -follow-up/monitor and evaluate

Which of the following are questions a RPH should consider when assessing the "safety" of a patient's medication therapy?

-patient experiencing allergy -any drug-drug, drug-disease, or drug-food interactions

Tools to aid in screening for and assessing fall risk

1. STEADI *if answers yes to any of the *check visual acuity 2. 3 questions 3. TUG *12 sec to complete the task 4. 30-sec chair stand test 5. 4-stage balance test

Lipitor/Atorvastatin dose range

10, 20, 40, 80

Warfarin INR target is between

2 and 3

Warfarin impairs the formation of vitamin-k clotting factors

2, 7, 9, 10 and protein C&S

80-year old female fall risk

33% risk of fall

age previous fall hypotension corrective lenses chronic condition

5 fall risk

Crestor/Rosuvastatin dose range

5, 10, 20, 40