A patient is in the clinic for a follow-up examination after a ...

[Mr. Wonderful]

A patient is in the clinic for a follow-up examination after a myocardial infarction (MI). The patient has a history of left ventricular systolic dysfunction. The primary care NP should expect this patient to be taking:
 
  a. nadolol (Corgard).
  b. carvedilol (Coreg).
  c. timolol (Blocadren).
  d. propranolol (Inderal).

Question 2

An 80-year-old patient with chronic stable angina has begun taking nadolol (Corgard) 20 mg once daily in addition to taking nitroglycerin as needed. After 1 week, the patient reports no change in frequency of nitroglycerin use.
 
  The primary care nurse practitioner (NP) should change the dose of nadolol to _____ mg _____ daily. a. 40; once
  b. 80; once
  c. 20; twice
  d. 40; twice

[cpetit11]

Answer to Question 1

B
The 2012 guides for prevention of cardiovascular disease recommend that B-blocker therapy should be used in all patients with left ventricular systolic dysfunction with heart failure or prior MI. Use should be limited to carvedilol, metoprolol succinate, or bisoprolol.

Answer to Question 2

A
B-Blockers are the treatment of choice for chronic stable and unstable angina. Their therapeutic effect is dose dependent, and drug titration should be based on frequency of angina symptoms and nitroglycerin use. Nadolol should be started at 20 mg daily for elderly patients when treating angina and should be increased by 20 mg every 3 to 7 days if symptoms do not improve. Nadolol is given once daily.

[Mr. Wonderful]

TYSM

[Joy Chen]

Excellent