Patient-Centered Care Flashcards

A 67-year-old male with Type 2 Diabetes presents to the clinic for follow-up. His recent lab results include: A1C: 8.4% Blood Pressure: 138/88 mmHg LDL cholesterol: 112 mg/dL Current medications: Metformin 1000 mg BID, Lisinopril 10 mg daily. Which of the following interventions is MOST appropriate to optimize his therapy?

Answer: Add Empagliflozin 10 mg daily

The patient's A1C of 8.4% indicates uncontrolled Type 2 Diabetes despite metformin. Empagliflozin, an SGLT2 inhibitor, is a highly recommended addition for patients with diabetes and established cardiovascular disease or risk factors, as it not only lowers glucose but also provides significant cardiovascular and renal protective benefits. This makes it a primary choice for optimizing his diabetes management and overall health outcomes.

A 55-year-old female with a 10-year history of hypertension and dyslipidemia reports muscle aches after starting Simvastatin 40 mg. Labs show normal kidney and liver function. What is the BEST next step?

Answer: Discontinue Simvastatin and start Atorvastatin 10 mg

Muscle aches (myalgia) are a common side effect of statins, and Simvastatin 40 mg carries a higher risk of myopathy compared to other statins. Switching to a different statin like Atorvastatin at a lower, equivalent intensity dose (e.g., Atorvastatin 10 mg) can often alleviate muscle symptoms while maintaining lipid-lowering efficacy. This strategy allows the patient to continue statin therapy with potentially fewer side effects.

A 72-year-old patient with heart failure and reduced ejection fraction (HFrEF) is taking: Metoprolol succinate 25 mg daily Furosemide 40 mg daily Lisinopril 10 mg daily His symptoms are well-controlled, but his potassium is 5.4 mEq/L (normal 3.5-5.0). What is the MOST appropriate intervention?

Answer: Hold Lisinopril temporarily

The patient has hyperkalemia (potassium 5.4 mEq/L), which is a known side effect of ACE inhibitors like Lisinopril, especially in patients with heart failure or renal impairment. Since Lisinopril contributes to potassium retention, temporarily holding the medication is the most appropriate immediate intervention to allow potassium levels to normalize and prevent further elevation. Once potassium is controlled, the need for an ACE inhibitor can be re-evaluated.

A 60-year-old man with COPD presents with increasing dyspnea and a recent exacerbation. Current medications: Tiotropium 18 mcg daily Albuterol inhaler PRN What is the BEST addition to his therapy?

Answer: Start Fluticasone/Salmeterol (ICS/LABA)

The patient has COPD with increasing dyspnea and a recent exacerbation, indicating a need for escalation of therapy beyond a LAMA and PRN SABA. For patients with COPD who experience exacerbations despite bronchodilator therapy, adding an inhaled corticosteroid (ICS) in combination with a long-acting beta-agonist (LABA) is recommended to reduce exacerbation frequency and improve lung function. This combination therapy aligns with current COPD management guidelines.

A 50-year-old woman with obesity, hypertension, and osteoarthritis seeks advice on lifestyle changes for managing her hypertension. What is the MOST effective intervention for lowering blood pressure?

Answer: DASH diet

The DASH (Dietary Approaches to Stop Hypertension) diet is widely recognized as the most effective dietary intervention for lowering blood pressure. It is a comprehensive eating plan rich in fruits, vegetables, whole grains, and low-fat dairy, while being low in saturated and total fats, cholesterol, and sodium. Adhering to the DASH diet can significantly reduce blood pressure and improve overall cardiovascular health.