Josina is a 65 yo AA woman who presents to clinic feeling ti…

Josina is a 65 yo AA woman who presents to clinic feeling tired for the last 3 months.  She is able to complete some light housework and cook her dinners, but she has difficulty breathing when doing more activity such as grocery shopping and walking up stairs.  She sleeps on 2 pillows at night to help with her breathing. PMH:  Heart failure with reduced ejection fraction (class III, stage C) HTN, arthritis. Physical exam: Edema of her feet and ankles (2+) with some crackles noted in the lungs on inspiration Medications:  HCTZ (Hydrodiuril*) 12.5mg daily, and ibuprofen (Motrin* / Advil*) 200mg BID for arthritis in knee. Vitals:  height 5’2″, 63kg, BP 134/84, HR 78, EF 35% per echocardiogram.  Which of the following is most appropriate regarding diuretic therapy for Josina?

Mr. Damone, a 59 year old man, presents to the emergency dep…

Mr. Damone, a 59 year old man, presents to the emergency department with crushing chest discomfort. An ECG indicates a small transmural left ventricular free wall infarction. The patient is given several drugs, for both immediate management of ischemia and for long term prevention of a subsequent MI. Which of the following drugs would provide immediate relief of the symptoms of myocardial ischemia, but has no long term effects on mortality (i.e. reducing the risk of sudden cardiac death or ventricular dysfunction)?

A 45-year-old female presents to the clinic with complaints…

A 45-year-old female presents to the clinic with complaints of severe pain in her lower back, radiating down her left leg. She describes the pain as burning and shooting, with occasional numbness and tingling. Physical examination reveals decreased sensation in the left L5 dermatome and diminished reflexes in the left lower extremity. Based on these findings, the nurse practitioner suspects lumbar radiculopathy. Which of the following medications would be the most effective for managing the patient’s neuropathic pain?

A 47-year-old woman with hypertension (HTN), hypothyroidism,…

A 47-year-old woman with hypertension (HTN), hypothyroidism, and osteoarthritis comes to the clinic for a blood pressure follow-up. She was given a diagnosis of HTN 6 months ago and has been unable to get to goal. Today, her blood pressure is 154/88 mm Hg (with similar repeat) and heart rate is 92 beats/minute. She currently takes chlorthalidone (Hygroton*) 25 mg/day, losartan (Cozaar*) 100 mg/day, amlodipine (Norvasc*) 10 mg/day, ibuprofen (Motrin*) 800 mg four times daily, and levothyroxine (Synthroid*) 100 mcg/day. She is adherent to her medications and has asked not to take any more blood pressure medications. Which would best address her elevated blood pressure?