The Art of the Counsel
Patients smoking tobacco should be counseled for smoking cessation. Every counsel should be initiated with this question.
Your patient receives a new prescription for nitroglycerin 0.4 mg SL PRN for chest pain. You notice he currently takes sildenafil 50mg PO qday to be used 60 minutes prior to sexual activity. What do you do?
Sildenafil should not be used with nitrates and must be discontinued. (Of note, SL nitroglycerin can be used in someone who has taken nitrates in the case of an emergency, such as probable MI, if properly monitored)
From the following list, which antipsychotic has the highest risk of qtc prolongation?
Aripiprazole, olanzapine, risperidone, ziprasidone
Geodon (Ziprasidone)
Your patient is starting a basal-bolus insulin regimen for type 1 DM. She weighs 72 kg. What's the recommended basal and bolus dosing regimen?
0.5 units/kg/day (recommended starting dose), divide by 2 then administer 50% as basal and 50% as bolus
Basal 18 units qday, bolus 6 units TID with meals
The brand names for the SGLT-2 inhibitors dapagliflozin, empagliflozin, canagliflozain, and sotagliflozin
What is Farxiga, Jardiance, Invokana, and Inpefa
The spirit of motivational interviewing should guide our patient counseling. Techniques such as "OARS" should be included in our counsel. What does "OARS" stand for?
Open-ended questions, Affirmations, Reflective Listening, Summarizing listening
Your patient takes lisinopril 20 mg qday and develops swelling around the lips and mouth. What do you recommend?
Stop the medication immediately due to angioedema
This antidepressant should be avoided in patients with bulimia and/or a seizure disorder
What is bupropion
If a patient is on furosemide 20 mg PO qday, what is an equivalent dose of oral bumetanide?
0.5 mg
Remember:
Furosemide 40 mg = torsemide 20 mg = bumetanide 1 mg
The generic names for Vasotec, Zestril, Accupril, Altace, Cozaar, and Diovan.
What is enalapril, lisinopril, quinapril, ramipril, losartan and valsartan.
Your patient has a new prescription for amiodarone. We are in sunny florida. What counseling point is important for your patient which may require a behavioral change?
Patient needs to apply sun protection to protect from photosensitivity (other answers may be accepted)
Your patient has HFrEF with stage C, class II symptoms. He is currently taking Entresto 24/26 mg BID, Farxiga 10 mg qday, Metoprolol succinate 100 mg qday, and spironolactone 25 mg qday. His BP is 120/80 mmHg and his HR is 52 bpm. Which medication requires titration and what do you recommend for a dose increase?
What is Entresto and 48/52 mg BID.
This antidepressant carries a risk of qtc prolongation and priapism, especially at higher doses.
What is trazodone
Your patient has been on an amiodarone drip for 12 hours. He received a 150 mg bolus followed by 1 mg/minute for 6 hours, then 0.5 mg/minute for 6 hours. How many mg of amiodarone has he received and what is our goal loading dose?
690 mg - our goal is 6-10 grams total loading dose
The brand names for the three evidence based beta blockers used for GDMT in heart failure to reduce mortality
Toprol XL, Coreg, and Zebeta (brand may be dc'd)
Your patient started taking isosorbide mononitrate 60 mg qday and he develops a headache. What do you recommend? (Include what to do with medication and any OTCs you can recommend)
Headaches are a common side effect of nitrates (up to about 55% patients experience HAs) A lower dose may reduce the side effect. However, he should continue taking as prescribed unless he discusses with his provider. Additionally, the side effect will likely go away with continued use and in the meantime, acetaminophen can be taken (if there's no contraindication) to manage his headache (generally avoid NSAIDs in patients with cardiac disease)
Your patient recently started Chantix. He is taking 1 mg BID. He is experiencing nausea. He is sucessfully abstaining from cigarette smoking. What change can you recommend to reduce this side effect so he can continue with the therapy?
Reduce dose to 0.5 mg BID, can also ensure he taking with a class of water, taking with food can sometimes reduce nausea
You receive an order for Zyprexa Relprevv 10 mg IM qday. What error does this order contain?
Zyprexa Relprevv is the long acting injectable available as 210 mg or 405 mg given every 2 or 4 weeks, Zyprexa is available as 10 mg IM injection for daily use.
IV to PO is 0.75 to 1, so about 28 mcg IV
Generic names for Trulicity, Mounjaro, Ozempic, and Victoza?
GLP 1 agonists - dulaglutide, tirzepatide, semaglutide, and liraglutide
Your patient is taking Jardiance 25 mg qday for Type II diabetes. He calls to report new onset itching, redness, and white discharge on his genitals. How do you counsel your patient? (Please include name of side effect, OTC or RX recommendations, when to start, what to do with his Jardiance, and any other pertinent information)
Name two antihypertensive agents which must be tapered prior to discontinuation.
Clonidine and beta blockers
What are EKG and electrolytes for 3 days. Each day consisting of at least 1 set of labs (BMP and magnesium) and 2 EKGS (1 following each dose of the BID drug)
A patient's lipid profile is listed below. Using the Friedewald equation, which is her estimated LDL?
TC: 250 mg/dL
HDL: 45 mg/dL
TG: 170 mg/dL
LDL?
Friedewald equation:
LDL = TC -HDL - TG/5
250-45 - 170/5 = 171
What's the brand name for thyroid desiccated USP (T3 and T4)?
Armour Thyroid