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Chronic Disease Management Flashcards

7 cards from real AANP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 58-year-old patient with type 2 diabetes has an HbA1c of 8.9%. Current treatment is metformin 1000 mg twice daily. Which is the most appropriate next step?

    Answer: Add a GLP-1 receptor agonist

    Adding a GLP-1 receptor agonist to metformin is guideline-recommended when HbA1c remains above goal; it provides cardiovascular and weight benefits with low hypoglycemia risk.

  2. A patient with stage 3 chronic kidney disease (eGFR 42 mL/min) and type 2 diabetes asks about medication adjustments. Which agent requires dose reduction or avoidance at this eGFR?

    Answer: Metformin

    Metformin is contraindicated when eGFR falls below 30 and requires caution/dose reduction between 30–45 mL/min due to risk of lactic acidosis.

  3. A 65-year-old with COPD is on a short-acting bronchodilator PRN. Spirometry shows FEV1/FVC < 0.70 and FEV1 55% predicted. He reports two exacerbations in the past year. What is the most appropriate maintenance therapy?

    Answer: Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA)

    GOLD guidelines recommend dual bronchodilation with LAMA+LABA for COPD group E patients (high symptom burden and ≥2 exacerbations), with ICS added only if eosinophils are elevated.

  4. A patient with heart failure with reduced ejection fraction (HFrEF, EF 35%) is already on an ACE inhibitor and beta-blocker at target doses. Which additional medication has been shown to reduce mortality in this patient?

    Answer: Spironolactone

    Aldosterone antagonists such as spironolactone reduce mortality in HFrEF when added to ACE inhibitor and beta-blocker therapy, per the RALES trial.

  5. A 72-year-old patient with hypertension and stage 3a CKD has a blood pressure of 148/88 mmHg on amlodipine 10 mg. Which antihypertensive class should be added first?

    Answer: ACE inhibitor or ARB

    ACE inhibitors and ARBs are preferred add-on agents in CKD with hypertension because they reduce proteinuria and slow progression of kidney disease.

  6. A patient with osteoporosis has a T-score of -2.6 at the lumbar spine. She is already taking calcium and vitamin D. What is the first-line pharmacologic treatment?

    Answer: Alendronate

    Bisphosphonates such as alendronate are first-line pharmacologic therapy for osteoporosis due to their proven efficacy in reducing vertebral and hip fractures.

  7. A 55-year-old male with hyperlipidemia has an LDL of 145 mg/dL. He has a 10-year ASCVD risk of 12% calculated by the Pooled Cohort Equations. Which intervention is indicated?

    Answer: Moderate-intensity statin therapy

    ACC/AHA guidelines recommend moderate-intensity statin therapy for intermediate-risk patients (10-year ASCVD risk 7.5–20%) to lower LDL by 30–49%.