Medication Management Flashcards

A 58-year-old female with a history of hypertension and osteoarthritis is being treated with the following medications: Lisinopril 10 mg daily Hydrochlorothiazide (HCTZ) 25 mg daily Ibuprofen 400 mg TID for knee pain She complains of worsening blood pressure readings, now averaging 150/92 mmHg. What is the MOST likely reason for her uncontrolled blood pressure?

Answer: Ibuprofen use

Nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen are known to cause an increase in blood pressure, especially in patients with pre-existing hypertension who are already on antihypertensive medications. NSAIDs can counteract the effects of antihypertensive drugs by causing sodium and water retention and by interfering with prostaglandin synthesis, leading to vasoconstriction. Given her worsening blood pressure, Ibuprofen is the most likely culprit.

A 65-year-old male with heart failure with reduced ejection fraction (HFrEF, EF 35%) is currently on the following medications: Carvedilol 6.25 mg BID Lisinopril 10 mg daily Furosemide 40 mg daily His blood pressure is 110/70 mmHg, and he is asymptomatic. What is the NEXT best step in optimizing his therapy?

Answer: Increase Carvedilol to 12.5 mg BID

The patient has HFrEF and is on guideline-directed medical therapy, but the doses of his beta-blocker (Carvedilol) and ACE inhibitor (Lisinopril) are below target doses. Since he is asymptomatic and his blood pressure is stable, the next best step is to titrate his beta-blocker (Carvedilol) to the maximum tolerated dose. Beta-blockers are crucial for improving morbidity and mortality in HFrEF, and dose optimization is a priority when the patient is stable.

A 72-year-old woman with atrial fibrillation (AF) and a CHADS₂-VASc score of 4 is prescribed Apixaban 5 mg BID. Her labs show: Serum creatinine: 1.6 mg/dL Weight: 48 kg Age: 72 years What is the appropriate adjustment to her Apixaban dose?

Answer: Reduce Apixaban to 2.5 mg BID

For non-valvular atrial fibrillation, the standard dose of Apixaban is 5 mg BID. However, a dose reduction to 2.5 mg BID is indicated if a patient meets at least two of the following three criteria: age ≥ 80 years, body weight ≤ 60 kg, or serum creatinine ≥ 1.5 mg/dL. This patient meets two criteria (weight ≤ 60 kg and serum creatinine ≥ 1.5 mg/dL), so the dose should be reduced to 2.5 mg BID to minimize bleeding risk while maintaining efficacy.

A 60-year-old man with Type 2 Diabetes and albuminuria (urine albumin-creatinine ratio of 350 mg/g) is currently on Metformin 1000 mg BID. His blood pressure is 140/85 mmHg. Which of the following is the MOST appropriate addition to his therapy?

Answer: Empagliflozin

The patient has Type 2 Diabetes with albuminuria, indicating diabetic kidney disease. Empagliflozin, an SGLT2 inhibitor, is strongly recommended for patients with Type 2 Diabetes and chronic kidney disease (especially with albuminuria) due to its proven benefits in reducing the progression of kidney disease and cardiovascular events. It provides renoprotection beyond glucose lowering, making it the most appropriate addition.

A 64-year-old male with coronary artery disease (CAD) and a history of myocardial infarction is currently taking: Aspirin 81 mg daily Metoprolol succinate 50 mg daily Lisinopril 20 mg daily His LDL cholesterol is 110 mg/dL. What is the BEST addition to his therapy?

Answer: Add Atorvastatin 40 mg daily

The patient has coronary artery disease and a history of myocardial infarction, placing him in a very high-risk ASCVD category. For such patients, high-intensity statin therapy is recommended to achieve an LDL cholesterol reduction of at least 50% from baseline or to a target of <70 mg/dL. Atorvastatin 40 mg daily is a high-intensity statin that would effectively lower his LDL from 110 mg/dL and is a guideline-recommended therapy for secondary prevention.