QUESTION: 77

Which of the following beta-blocker is NOT proven to reduce mortality in patients with Systolic CHF?

Bisoprolol
Nadolol
Carvedilol
Metoprolol succinate
Metoprolol Tartrate

Answer(s): E

Explanation:

Nadolol is not proven to reduce mortality in patients with systolic CHF. The efficacy of nadolol in HF has not been determined. For patients taking nadolol, it should be used with caution in those with compensated heart failure and patients should be monitored for a worsening of the condition. Bisoprolol, carvedilol, and sustained- release metoprolol succinate are the beta-blockers that have been proven to reduce mortality in patients with systolic CHF. These 3 beta-blockers have been effective in reducing the risk of death in patients with chronic HFrEF. Other beta-blockers were found to be less effective. Bucindolol did not exhibit uniform effectiveness across different populations. Metoprolol tartrate was found to be less effective in HF clinical trials.

Reference:

http://circ.ahajournals.org/content/128/16/e240

Reveal Solution Next Question

QUESTION: 78

Alteplase is ordered for a 72 YOM who weighs 68kg for Ischemic stroke. The ER physician would like you to dose. As an ER pharmacist you know the dose is 0.9 mg/kg IV (not to exceed 90 mg); give 10% of the total dose as an IV bolus over 1 minute, then give the remaining 90% as an IV infusion over 60 minutes. After reconstitution, the concentration of Altaplace is 1mg/ml. How many ml is needed for the bolus and how many ml is needed for the infusion? Round to the nearest ml.

6ml IV bolus, followed by 55mL IV over 60 minutes
4ml IV bolus, followed by 57mL IV over 60 minutes
3ml IV bolus, followed by 58mL IV over 60 minutes
8ml IV bolus, followed by 52mL IV over 60 minutes
9ml IV bolus, followed by 82mL IV over 60 minutes

Answer(s): A

Explanation:

68kg × 0.9mg/kg = 61.2mg dose × 1mg/mL = 61.2mL 61.2mg × 0.1 = 6mL IV bolus 61.2mg × 0.9 = 55mL IV over 60 minutes

Reveal Solution Next Question

QUESTION: 79

TM is a 78 YOW with a history of hypertension, hypercholesterolemia and arthritis was admitted for proximal arterial fibrillation. While in the hospital she was placed on diltiazem drip and eventually, converted to oral diltiazem 240mg. Pt’s home medication includes Simvastatin 40mg po daily , hydrochlorothiazide 25mg po daily , Lisinopril 20mg daily and Acetaminophen. Her LDL-C is 100mg /dL.
What would be the most appropriate change to make on her therapy?

Increase Simvastatin to 80mg po daily
Keep Simvastatin at 40mg po daily
Change Simvastatin 40mg to Atorvastatin 40mg po daily
Change Simvastatin to Lovastatin 20mg po daily
Discontinue Statins.

Answer(s): C

Explanation:

Diltiazem has a major drug interaction with Simvastatin. Diltiazem is a CYP3A4 inhibitor, and since Simvastatin is metabolized by CYP3A4, its level can build up and the risk of myopathy increases. It is recommended to switch to a non-CYP3A inhibitor such as Pitavastatin, Pravastatin, or Rosuvastatin, and if Simvastatin is to be kept on it should not exceed 10 mg/day. The same interaction also exists with lovastatin, and the recommendation is to not exceed a total dose of 20 mg/day po of Lovastatin. Given the current options, the best choice is to change to Atorvstatin 40 mg po daily.

Reference:

http://www.fda.gov/Drugs/DrugSafety/ucm256581.htm http://circ.ahajournals.org/content/129/25_suppl_2/S1

Reveal Solution Next Question

QUESTION: 80

A patient who weighs 80kg is ordered Esmolol at 50mcg/kg/min. Esmolol comes in 2500mg/250 ml NS premixed bags. What is the infusion rate in mls/hr?

20mls/hr
6mls/hr
8mls/hr
24mls/hr
32mls/hr

Answer(s): D

Explanation:

50 mcg/kg/min × 80 kg = 4 mg/min × 60 min/hr = 240 mg/hr 2500 mg / 250 mL = 10 mg/mL 240 mg/hr / 10 mg/ mL = 24 mL/hr Esmolol Infusion

Reveal Solution Next Question

Free NAPLEX Exam Braindumps (page: 20)

QUESTION: 77

Explanation:

Reference:

QUESTION: 78

Explanation:

QUESTION: 79

Explanation:

Reference:

QUESTION: 80

Explanation: