BCACP - Board Certified Ambulatory Care Pharmacist Cardiovascular Disease Management Questions and Answers — Questions and Answers
Question 1: A 68-year-old male with a history of myocardial infarction 2 years ago presents for a follow-up visit. His current medications include atorvastatin 80 mg daily, lisinopril 20 mg daily, metoprolol succinate 100 mg daily, and aspirin 81 mg daily. His recent lipid panel shows an LDL-C of 85 mg/dL. According to the 2026 ACC/AHA Guideline on the Management of Dyslipidemia, which of the following is the most appropriate next step?
- Continue current therapy and recheck lipids in 6 months.
- Add ezetimibe 10 mg daily. (Correct answer)
- Increase atorvastatin to 80 mg twice daily.
- Initiate fenofibrate for additional LDL-C lowering.
Correct answer: Add ezetimibe 10 mg daily.
According to the 2026 ACC/AHA dyslipidemia guidelines, patients with clinical atherosclerotic cardiovascular disease (ASCVD) are considered at very high risk. The recommended LDL-C goal for this population is less than 55 mg/dL. Since the patient is already on maximally tolerated high-intensity statin therapy and his LDL-C remains above goal, the next step is to add a non-statin agent. Ezetimibe is the recommended first-line add-on therapy.
Question 2: A 52-year-old female is diagnosed with Stage 1 hypertension with a blood pressure reading of 136/88 mmHg. She has no other medical conditions. Her calculated 10-year PREVENT-ASCVD risk score is 4%. Based on the 2025 ACC/AHA hypertension guideline, what is the MOST appropriate initial recommendation?
- Initiate hydrochlorothiazide 12.5 mg daily.
- Initiate amlodipine 5 mg daily.
- Recommend lifestyle modifications and re-evaluate in 1 month.
- Recommend lifestyle modifications, including dietary changes and physical activity, and re-evaluate in 3-6 months. (Correct answer)
Correct answer: Recommend lifestyle modifications, including dietary changes and physical activity, and re-evaluate in 3-6 months.
The 2025 ACC/AHA hypertension guideline recommends initiating antihypertensive medication for Stage 1 hypertension if the patient has clinical ASCVD or a 10-year PREVENT risk of ≥7.5%. For patients with Stage 1 hypertension and a lower risk (<7.5%), a 3- to 6-month trial of lifestyle modification is recommended before initiating pharmacotherapy.
Question 3: Which of the following medication classes is now considered one of the four essential pillars of guideline-directed medical therapy (GDMT) for all patients with heart failure with reduced ejection fraction (HFrEF), regardless of diabetes status?
- Ivabradine
- Digoxin
- Sodium-glucose cotransporter-2 (SGLT2) inhibitors (Correct answer)
- Loop diuretics
Correct answer: Sodium-glucose cotransporter-2 (SGLT2) inhibitors
The 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure establishes four foundational medication classes for HFrEF: 1) Renin-angiotensin system inhibitors (ARNI, ACEi, or ARB), 2) Beta-blockers, 3) Mineralocorticoid receptor antagonists (MRAs), and 4) SGLT2 inhibitors. SGLT2 inhibitors are recommended for all patients with symptomatic chronic HFrEF to reduce hospitalizations and cardiovascular mortality, irrespective of the presence of type 2 diabetes.
Question 4: A 76-year-old female with hypertension and type 2 diabetes is newly diagnosed with paroxysmal atrial fibrillation. She has no history of stroke. What is her CHA2DS2-VASc score, and what is the most appropriate anticoagulant recommendation according to the 2023 ACC/AHA/ACCP/HRS guideline?
- Score of 3; recommend aspirin 81 mg daily.
- Score of 4; recommend apixaban or another direct oral anticoagulant (DOAC). (Correct answer)
- Score of 2; shared decision-making regarding oral anticoagulation.
- Score of 4; recommend warfarin with a target INR of 2.0-3.0.
Correct answer: Score of 4; recommend apixaban or another direct oral anticoagulant (DOAC).
The CHA2DS2-VASc score is calculated as follows: C (Congestive heart failure) = 0, H (Hypertension) = 1, A2 (Age ≥75) = 2, D (Diabetes) = 1, S2 (Stroke/TIA/TE) = 0, V (Vascular disease) = 0, A (Age 65-74) = 0, Sc (Sex category - female) = 1. The total score is 1+2+1 = 4. A score of ≥2 in males or ≥3 in females indicates a recommendation for oral anticoagulation. The 2023 guidelines strongly recommend a direct oral anticoagulant (DOAC) over warfarin for most patients.
Question 5: A 65-year-old man with hyperlipidemia but no history of ASCVD, diabetes, or increased bleeding risk asks about starting aspirin for primary prevention of a heart attack. His 10-year ASCVD risk is calculated to be 12%. According to the 2022 US Preventive Services Task Force (USPSTF) recommendations, what should the pharmacist advise?
- Aspirin is strongly recommended and should be initiated immediately.
- Aspirin initiation can be considered after a shared decision-making discussion of risks and benefits.
- Aspirin should not be initiated for primary prevention in this age group. (Correct answer)
- Aspirin should only be started if his ASCVD risk is >20%.
Correct answer: Aspirin should not be initiated for primary prevention in this age group.
The 2022 USPSTF guidelines recommend against routinely initiating low-dose aspirin for the primary prevention of ASCVD in adults 60 years or older. The potential for harm from bleeding outweighs the potential benefits in this age group. Therefore, aspirin should not be initiated.
Question 6: A patient with newly diagnosed atrial fibrillation and a BMI of 31 kg/m² is being counseled on management strategies. According to the 2023 AFib guidelines, which of the following non-pharmacologic interventions is a pillar of management to prevent disease progression and adverse outcomes?
- High-intensity interval training for 30 minutes weekly.
- Strict limitation of dietary potassium.
- A low-carbohydrate, high-fat diet.
- Weight loss and moderate-intensity exercise targeting 210 minutes per week. (Correct answer)
Correct answer: Weight loss and moderate-intensity exercise targeting 210 minutes per week.
The 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation identifies lifestyle and risk factor modification as a central pillar of management. For patients with a BMI >27 kg/m², weight loss is recommended. The guideline also recommends moderate-to-vigorous exercise, targeting 210 minutes per week, to reduce AFib burden and improve symptoms.
BCACP - Board Certified Ambulatory Care Pharmacist Cardiovascular Disease Management Questions and Answers
A 68-year-old male with a history of myocardial infarction 2 years ago presents for a follow-up visit.
His current medications include atorvastatin 80 mg daily, lisinopril 20 mg daily, metoprolol succinate 100 mg daily, and aspirin 81 mg daily.
His recent lipid panel shows an LDL-C of 85 mg/dL.
According to the 2026 ACC/AHA Guideline on the Management of Dyslipidemia, which of the following is the most appropriate next step?