Discuss NABP NAPLEX Exam Topic 2 Question 39

JK is a 67 years old African American man who presents to your clinic for his blood pressure management. His past medical history includes Peptic ulcer disease and hypertension. His two BP readings are 160/98, 159/96 and HR 85. He says he has been adherent to his medication and lifestyle. He currently takes 12.5mg Chlorthalidone and Prilosec 20mg daily.

Which of the following is the best strategy to manage his blood pressure?

AIncrease chlorthalidone to 25mg daily

BAdd Norvasc 2.5 daily

CAdd Lisinopril 5mg daily

DAdd hydrochlorothiazide 25mg daily

EAdd Lisinopril 20mg daily

Suggested Answer: B

As the patient is over the age of 60 and he does not have CKD or diabetes, his goal BP should be SBP < 150 mmHg or DBP < 90 mmHg, and he is not currently at this goal with his medication regimen. Options are to maximize the current medication dosage (option A), or to add a second agent. Since calcium channel blockers like Norvasc are recommended as initial treatment options in African Americans, choosing Norvasc over lisinopril would probably be the more effective option.

http://jamanetwork.com/journals/jama/fullarticle/1791497

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12 comments · newest first

Tesha 11 months ago

I disagree, adding hydrochlorothiazide seems redundant here.

Margurite 12 months ago

Surprised they didn't mention lifestyle changes more!

Rebeca 12 months ago

Isn't Lisinopril a good option too?

Regenia 12 months ago

I think adding Norvasc makes more sense for better control.

Sharita 1 year ago

Chlorthalidone is a thiazide, so increasing it could help.

Martha 1 year ago

I'm a bit confused about the differences between the options. Should we consider his peptic ulcer disease when choosing a medication?

Alyssa 1 year ago

I think adding Norvasc could be a good choice since it’s a calcium channel blocker and might help with his hypertension.

Lavelle 1 year ago

I remember that chlorthalidone is a thiazide-like diuretic, but I'm not sure if increasing the dose is the best option here.

Jolanda 1 year ago

I practiced a similar question where adding an ACE inhibitor was the right answer. I wonder if Lisinopril would be effective for this patient too.

Alpha 1 year ago

This seems like a straightforward networking question. I think I'll go with option B - creating a serverless VPC access connector for each serverless service to connect to the existing microservices. That way, I don't have to worry about configuring firewall rules or peering VPCs, which could get complicated.

Selene 1 year ago

I'm not totally sure, but using SNS or SQS to notify the on-premises system sounds like a good way to automate the dashboard update, right?

Nell 1 year ago

This is a good one. I'm leaning towards the standard deviation approach. That way, I don't have to worry about the units or the range of the data. Just normalize everything and let the clustering algorithm do its thing. Gotta love when they throw in these little twists to test our understanding.

NABP NAPLEX Exam - Topic 2 Question 39 Discussion