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AANP FNP study materials
AANP FNP study resources

AANP FNP: Clinical Management: Pharmacologic and Non-pharmacologic Plan of Care

AANP FNP · Work through your exam, one topic at a time.

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Clinical Management: Pharmacologic and Non-pharmacologic Plan of Care

Think in algorithms

Management questions test first-line, guideline-concordant therapy plus safety. Know the starting drugs for hypertension (thiazide, ACE inhibitor/ARB, or calcium channel blocker; two-drug single-pill therapy for stage 2), type 2 diabetes (metformin plus a GLP-1 receptor agonist or SGLT2 inhibitor when there is ASCVD, heart failure, or CKD), asthma (ICS-formoterol as reliever and controller; never a lone SABA), COPD (LAMA/LABA, with ICS reserved for exacerbation or eosinophilic phenotypes), and uncomplicated UTI (nitrofurantoin 5 days where renal function permits, or fosfomycin).

Safety always outranks potency

Screen every prescription for renal and hepatic dosing, pregnancy and lactation status, age-related risk (Beers criteria: avoid benzodiazepines, anticholinergics, sulfonylureas with long action in frail elders), and interactions. Watch CYP3A4 inhibitors and inducers, warfarin interacting drugs, serotonergic combinations, and QT prolongation. Review the med list for deprescribing opportunities at every visit.

Non-pharmacologic care is not optional

Every plan should include counseling, physical activity, sleep hygiene, sodium and alcohol limits, vaccination, and referral to behavioral health or physical therapy where indicated. Teach-back confirms understanding.

Traps

  • Combining an ACE inhibitor with an ARB, or an NSAID plus ACE inhibitor/ARB plus diuretic (the "triple whammy" for acute kidney injury).
  • Prescribing antibiotics for viral URI, acute bronchitis, or asymptomatic bacteriuria (treat only in pregnancy or before urologic instrumentation).
  • Missing renal dose reduction; forgetting that metformin should not be started at eGFR below 45 and should be stopped below 30.

Worked rule of thumb

For apixaban in atrial fibrillation: 5 mg twice daily, reduced to 2.5 mg twice daily only when at least two of three apply - age ≥80, weight ≤60 kg, creatinine ≥1.5 mg/dL. "Start low, go slow" applies to titratable drugs, not to anticoagulants.