Lynette is a 68 yo female who presents to your clinic for a follow up appointment after her recent heart failure diagnosis.  She complains of weakness, loss of appetite, and she is seeing a blue/green halo.  Her daughter comments that she has appeared confused over the past day or so.  Which medication may be causing these side effects?

Tyson is a 50 yo black male with a past medical history significant for hypertension and a heart attack (resulting in reduced LVEF) one year ago.  He is currently taking lisinopril (Zestril*) and a higher dose of amlodipine (Norvasc*).  He says he is having ankle edema over the past couple months since amlodipine (Norvasc*) was started.  His kidney function is normal, and he has no other signs/symptoms of fluid accumulation (e.g. pulmonary congestion, weight gain).  His BP is 138/70, and HR 72. His laboratory values are normal. Considering not only hypertension, but his past medical history ( prior MI / stable HFrEF) and most recent complaint (ankle edema), which of the following recommendations is most appropriate for Tyson to correct the edema and optimize heart failure therapy?

Angela is a 79yo Caucasian female with a history of heart failure with reduced ejection fraction (HFrEF) and hypertension.  Her BP is 142/76 and heart rate is 73 bpm.  Medications include carvedilol (Coreg*) 25mg twice daily, lisinopril (Zestril*) 40 mg daily, Empagliflozin (Jardiance*) 10mg daily and furosemide (Lasix*) 40 mg daily. She has been fairly compliant with the recommended lifestyle modifications.  Angela returns to your clinic 2 months later with a new complaint of a dry cough.  Her lungs are clear, weight and labs are unchanged, and she has no other symptoms.  Which of the following is most appropriate?

John is a 57yo Caucasian male who presents for a routine visit for his hyperlipidemia.  His PMH includes hyperlipidemia and hypertension.  He has no family history of heart disease.  He is a current smoker (1 PPD x 45 years).  He currently takes quinapril (Accupril*) 20mg daily.  Vitals include BP 165/90 x 2, HR 84, EKG shows normal sinus rhythm.  Weight 210 lbs, ht 5’10”.  Fasting labs include K 5.1 , Cr 1.1 [

NJ is receiving 40 mg po morphine/day.  You wish to convert him to po oxycodone (Oxy IR).  Which of the following regimens is the best recommendation for this patient?   Assume a 25% reduction for incomplete cross tolerance.  The following conversions are provided for you:   Drug IV (mg) Oral (mg) Morphine 10 30 Oxycodone N/A 20

Tess is a 55yo African American female with a PMH of HTN, DM and hyperlipidemia.  She weighs 175 lbs and is 5’4″. She sometimes eats processed foods and admits to having trouble with portion control. She does not exercise regularly and she does not smoke.  Her mother had a MI at the age of 70.  Her fasting lipid profile shows TC 200 [

HP is a 73 yo female who brought to the ED with altered mental status, but is unable to reliably describe any other symptoms. Urinalysis would demonstrate cloudy colored urine, (+) for  RBCs, WBCs, nitrites as well as leukocyte esterases.  Her culture shows >100,000 bacteria in the urine.  TRUE or FALSE:  You would treat this patient for a urinary tract infection (UTI).  

Kern, 72-year-old male presented at the hospital complaining of severe pain in his left leg, shortness of breath, and pleuritic type chest pain following a long drive from Connecticut to Florida with minimal stopping. The patient had a history of pulmonary embolism, degenerative joint disease, and previously was a chronic smoker. His vital signs were: temperature 38.4 °C, pulse 98 bpm, respiratory rate 20 breaths per minute, and blood pressure 138/90 mm Hg. Basic metabolic panel and complete blood count values were within the normal range. Kern is  diagnosed with a new DVT. Kern is given an appropriate loading dose (bolus) of heparin (Half-Life ≈ 1.5 hrs) and started on a heparin infusion at an initial rate of 18 units/kg/hr. Six hours after starting the initial infusion, Kern’s aPTT is 37 seconds. (Institution-specific therapeutic range is 46-70 seconds). What should be done?

Which medication is considered to be the drug of choice for children with acute otitis media? Assume no drug allergies or recent antibiotic therapy.

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?