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MOST COMMON ARRYTHMIA WITH MITRAL REGURGITATION AND WHAT MED WILL HELP -------- Correct Answer ------- A FIB START ANTICOAGULATION= COUMADIN The most common arrhythmia associated with mitral regurgitation (MR) is atrial fibrillation. Anti-coagulation with warfarin will help prevent arterial embolism that can result in stroke or myocardial infarction. Atrial fibrillation occurs because the fibers in the atrium are stretched as the atrium dilates. The stretch results in conduction defects, notably, atrial fibrillation. WHICH B/P MED IS CONTRAINDICTED WITH SOMEONE WHO HAS A SULFA ALLERGY -------- Correct Answer--------HCTZ This patient's allergy to "sulfa" sounds like Stevens Johnson Syndrome, a potentially life-threatening allergic reaction. Hydrochlorothiazide has a sulfonamide ring in its chemical structure, generally referred to as "sulfa". This sulfonamide ring can initiate an allergic reaction in patients with sulfa allergy. Since the patient's allergic reaction to sulfa was so serious, other sulfonamide medications should be completely avoided until consultation with an allergist. The other medications can be used without concern in the presence of a patient with a sulfa allergy because there is no sulfonamide component. An older adult has renal insufficiency, hypertension, osteoarthritis, hypothyroidism, and varicose veins. Which medication should be avoided? Acetaminophen Beta blockers NSAIDs Low dose aspirin -------- Correct Answer --------NSAID NSAIDs are contraindicated in patients who have renal insufficiency. They may produce a transient decrease in renal function and likely produce sodium retention and thus, water retention. For the same reason, this may worsen hypertension. Acetaminophen, mild narcotics, and/or topical agents could be used to treat her osteoarthritis. NSAIDs will have no effect on her varicose veins or hypothyroidism. ACE COUGH -------- Correct Answer-------- USUALLY BEGINS WITHIN A WEEK AND IS DRY AND NON-PRODUCTIVE It is more common in women than men and is thought to be due to the buildup of bradykinin. Bradykinin is partly degraded by ACE (angiotensin converting enzyme). When degradation is impaired, bradykinin can accumulate and cough can ensue. A common side effect of thiazide diuretics is: prostatitis. erectile dysfunction. fatigue. hyperkalemia -------- Correct Answer--------ERECTILE DYSFX Several studies have demonstrated that erectile dysfunction (ED) was associated with use of thiazide diuretics, specifically chlorthalidone. When ED was evaluated in patients taking chlorthalidone, acebutolol, amlodipine, enalapril, and doxazosin (the major antihypertensive drug classes), the thiazide diuretic, chlorthalidone had the greatest incidence of ED. The other drugs in the study were no more likely to cause ED than a placebo. However, a common complaint of men on antihypertensive medications is ED. This should always be evaluated as a side effect of antihypertensive treatment. PAD -------- Correct Answer--------An absence of hair growth likely indicates peripheral artery disease in this patient. It is part of normal changes of aging that hair growth will diminish, but not become absent. His lower extremity pulses should be assessed, his cardiac risk factors should be assessed (he smoked for years), and he should be questioned about leg pain when he walks. An ankle-brachial index could be measured. If < 0.9, further assessment should be done. A normal ankle-brachial index should be greater than 0.9. Less than 0.4 is considered critical. A patient who has hyperlipidemia should have: a statin daily. a thyroid stimulating hormone (TSH) level. second lipid measurement to confirm diagnosis. ] stress test done. -------- Correct Answer-------- TSH If a patient's lipids are elevated, a TSH should be performed. If the TSH is elevated, it may be the secondary cause of the elevated lipids. It is considered safe practice to NOT treat elevated lipid levels until the TSH level has decreased to at least 10 mU/L. If the lipids are still elevated, they should be treated at that time. An overweight 76 year-old female with a recent onset of diabetes has longstanding hypertension and hyperlipidemia. She has develope