Contoh Soal Hipertensi + PTO HT +HL 02

Contoh soal PTO kasus
HT+HL+stroke
Dr Apt Azrifitria, MSi

Question #1
A 43 yo M is evaluated during a routine physical examination. He has
no current symptoms and no PMH. FH is notable for DM and HTN in 2
1st degree relatives. He takes no meds.
On physical exam, initial BP is 144/86; repeat measurement after 5

minutes of rest are 136/86 and 134/88. BMI is 32. The remainder of
the exam is normal.
Labs show normal Cr and plasma glucose levels.

In addition to lifestyle modifications, which of the
following is the most appropriate next step in the
management of this patient’s blood pressure?
A: Initiate a low dose ACE inhibitor
B: Initiate low dose chlorthalidone
C: Order ambulatory BP monitoring
D: Recheck blood pressure in 1 year

In addition to lifestyle modifications, which of the
following is the most appropriate next step in the
management of this patient’s blood pressure?
A: Initiate a low dose ACE inhibitor
B: Initiate low dose chlorthalidone
C: Order ambulatory BP monitoring
D: Recheck blood pressure in 1 year

Q
A 57 yo African American M is evaluated for treatment of newly
diagnosed HTN. History is notable for HLD, which is treated with
moderate-dose simvastatin.
On exam, BP 151/94, HR 72, BMI 28. Remainder of exam is

unremarkable.
Labs show Cr 1.0, fasting glucose 104, and K+ 4.5. A urine dipstick
demonstrates no blood or protein.
In addition to recommending lifestyle
modifications, which of the following
is the most appropriate initial anti-
hypertensive therapy for this patient?
A: Amlodipine
B: Diltiazem
C: HCTZ
D: Lisinopril
In addition to recommending lifestyle
modifications, which of the following
is the most appropriate initial anti-
hypertensive therapy for this patient?
A: Amlodipine
B: Diltiazem
C: HCTZ
D: Lisinopril
Question 98
A 60 yo woman is evaluated during a follow-up visit for HTN.
History is also notable for HLD. She tolerates her
medications well except for minor pedal edema since
starting her anti-hypertensive medication. She is active and
plays tennis 3x/wk. Current medications are amlodipine
5mg/d and rosuvastatin.
On exam, the average of 2 BP readings is 152/86 which is

consistent with measurements she has obtained at home for
3 months. HR 64, BMI 22. Trace pedal edema is noted.
Labs show normal chemistry panel and urine dipstick shows

no protein.
Which of the following is the most
appropriate next step in management?
A: Add Lisinopril
B: Add metoprolol
C: Increase amlodipine to 10mg/d
D: Continue current regimen

Which of the following is the most
appropriate next step in management?
A: Add Lisinopril
B: Add metoprolol
C: Increase amlodipine to 10mg/d
D: Continue current regimen

Answer
• Patient has stage 1 hypertension and JNC 8 recommends
BP goal <150/90 for patients >60 yo.
• She has no evidence of CV or kidney dx and is not frail and
has a longer expected lifetime than the general population
of this age, cautious stepped care for lower blood pressure
goals is reasonable.
• Increasing dose of 1 agent is less effective in reducing BP
then addition of 2nd agent at low dose, also avoids the risk
of SIDE EFFECTS
• Beta blocker is not indicated for the initial Rx of HTN
• ACCOMPLISH trial demonstrated benefit of combo therapy
with CCB and ACE inhibitor in reducing cardiovascular
events compared to using a thiazide and ACE inhibitor
Question 19
A 48 yo woman is evaluated during a follow up visit for
newly diagnosed HTN, confirmed by multiple measurements
at home and in the office. PMH of HLD for which she is
taking atorvastatin. Lifestyle modifications have been
recommended.
On exam, BP 160/92, HR 64, BMI 32. Remainder of exam

unremarkable.
Labs show Cr 1.1mg/dL, fasting glucose 114 and K+ 4.0,

urine dipstick demonstrates no blood or protein.
Which of the following is most likely to be
effective in controlling this patient’s HTN?
A: Amlodipine
B: Lisinopril
C: Losartan
D: Lisinopril and amlodipine
E: Losartan and lisinopril

Which of the following is most likely to be
effective in controlling this patient’s HTN?
A: Amlodipine
B: Lisinopril
C: Losartan
D: Lisinopril and amlodipine
E: Losartan and lisinopril

Question 10
A 51 yo M is evaluated during a follow up visit for management
of newly diagnosed hypertension and diabetes. He started a
program of lifestyle modifications for his DM, but hasn’t
started anti-hypertensive medication. He currently takes no
meds.
On exam, BP 148/92, HR 76, BMI 33. The remainder of the

exam was normal.
Labs show Cr 1.5, K+4.2, urine dipstick with no hematuria or

proteinuria and spot urine protein-creatinine ratio 50mg/g
Which of the following is the most appropriate
anti-hypertensive treatment for this patient?
A: HCTZ
B: Lisinopril
C: Lisinopril and amlodipine
D: Lisinopril and HCTZ
E: Lisinopril and losartan

Which of the following is the most appropriate
anti-hypertensive treatment for this patient?
A: HCTZ
B: Lisinopril
C: Lisinopril and amlodipine
D: Lisinopril and HCTZ
E: Lisinopril and losartan

Seorang pria usia 35 th didiagnosa oleh dokter hipertensi dengan tekanan darah 148 mmHg
dengan RR 80 x. Dari hasil anamnesis, pasien mempunyai riwayat asma dan PPOK/COPD.
Obat antipertensi manakah yang saudara rekomendasaikan pada pasien tersebut
A. Timolol
B. Propranolol
C. Lisinopril
D. Furosemide
E. Amlodipine
Seorang perempuan usia 53 tahun datang ke klinik dengan keluhan sering lemas, pusing ,
dan jantung terasa berdebar debar. Setelah pemeriksaan dokter, pasien didiagnosa
hipertensi dan diabetes. Hasil pemeriksaan fisik diperoleh tekanan darah 148/92, HR 76,
dan BMI 33. Hasil laboratorium, gula darah sewaktu 225 mg/dL, Cr 1.5, K+4.2, dan tidak ada
proteinuria.
Berdasarkan ISH, Pengobatan antihipertensi yang direkomendasikan untuk pasien W adalah
A. Hidroklortiazid
B. Lisinopril dan hidroklortiazid
C. Lisinopril dan amlodipin
D. Lisinopril
E. Lisinopril dan candesartan
Seorang pasien perempuan, usia 56 th datang ke klinik mengeluhkan mudah lelah, pusing,
dan bengkak pada pergelangan kaki. Hasil anamnesis apoteker, riwayat obat yang diminum
pasien tiga bulan ini adalah amlodipine, captopril, simvastatin, dan omeprazol untuk terapi
hipertensi, hyperlipidemia, dan GERD nya. Pasien juga baru meminum amoxicillin karena
infeksi telinganya.
Obat manakah menurut saudara yang diduga menyebabkan efek samping pada pasien
tersebut
A Simvastatin
.
B. Omeprazole
C. Amlodipine
D Captopril
.
E. Amoxicillin
tugas 1.
Lakukan skrining;
 farmasetik,
 klinis
pada resep disamping

Tugas 2; analisis PCNE
• Data pasien
Tugas 3; analisis interaksi Obat
Tugas 4;analisis interaksi obat
Tugas 5 ; analisis interaksi obat
Tugas 6; stroke; analisis PCNE; di IGD, RANAP, obat pulang pasien

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Contoh soal PTO kasus

Dr Apt Azrifitria, MSi

On physical exam, initial BP is 144/86; repeat measurement after 5

Labs show normal Cr and plasma glucose levels.

A: Initiate a low dose ACE inhibitor

B: Initiate low dose chlorthalidone

C: Order ambulatory BP monitoring

D: Recheck blood pressure in 1 year

A: Initiate a low dose ACE inhibitor

B: Initiate low dose chlorthalidone

C: Order ambulatory BP monitoring

D: Recheck blood pressure in 1 year

On exam, BP 151/94, HR 72, BMI 28. Remainder of exam is

On exam, the average of 2 BP readings is 152/86 which is

Labs show normal chemistry panel and urine dipstick shows

C: Increase amlodipine to 10mg/d

D: Continue current regimen

C: Increase amlodipine to 10mg/d

D: Continue current regimen

On exam, BP 160/92, HR 64, BMI 32. Remainder of exam

Labs show Cr 1.1mg/dL, fasting glucose 114 and K+ 4.0,

D: Lisinopril and amlodipine

E: Losartan and lisinopril

D: Lisinopril and amlodipine

E: Losartan and lisinopril

On exam, BP 148/92, HR 76, BMI 33. The remainder of the

Labs show Cr 1.5, K+4.2, urine dipstick with no hematuria or

C: Lisinopril and amlodipine

D: Lisinopril and HCTZ

E: Lisinopril and losartan

C: Lisinopril and amlodipine

D: Lisinopril and HCTZ

E: Lisinopril and losartan

pada resep disamping

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