BCACP Cardiovascular Disease Management 2 — Questions and Answers
Question 1: A patient with heart failure with reduced ejection fraction (HFrEF) and CKD stage 3b (eGFR 32 mL/min) is started on sacubitril/valsartan. Which monitoring parameter is most critical in the first month?
- Serum potassium and creatinine (Correct answer)
- Liver function tests
- Complete blood count
- Thyroid-stimulating hormone
Correct answer: Serum potassium and creatinine
Sacubitril/valsartan can cause hyperkalemia and worsen renal function, especially in patients with pre-existing CKD, requiring close monitoring of potassium and creatinine.
Question 2: A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 2 (female sex, hypertension) asks about stroke prevention. Which recommendation is most appropriate?
- Anticoagulation therapy is recommended (Correct answer)
- Aspirin alone is sufficient
- No antithrombotic therapy is needed
- Clopidogrel plus aspirin is preferred
Correct answer: Anticoagulation therapy is recommended
A CHA₂DS₂-VASc score of 2 in a female patient (score accounting for female sex) with hypertension warrants oral anticoagulation therapy per current guidelines.
Question 3: Which beta-blocker has the strongest evidence for mortality reduction in patients with HFrEF and should be used preferentially?
- Carvedilol, metoprolol succinate, or bisoprolol (Correct answer)
- Atenolol
- Propranolol
- Labetalol
Correct answer: Carvedilol, metoprolol succinate, or bisoprolol
Only carvedilol, metoprolol succinate (extended-release), and bisoprolol have demonstrated mortality benefit in large HFrEF trials and are guideline-recommended.
Question 4: A 68-year-old patient with ASCVD is intolerant to statins due to myalgia confirmed on rechallenge. What is the most appropriate next step for LDL-C lowering?
- Ezetimibe plus a PCSK9 inhibitor (Correct answer)
- Niacin monotherapy
- Cholestyramine monotherapy
- Omega-3 fatty acids
Correct answer: Ezetimibe plus a PCSK9 inhibitor
In true statin-intolerant patients with ASCVD, ezetimibe combined with a PCSK9 inhibitor provides substantial LDL-C lowering and cardiovascular risk reduction.
Question 5: A patient with stable angina and hypertension needs antianginal therapy. Which agent treats both conditions and has the most evidence for reducing angina episodes?
- Amlodipine (Correct answer)
- Hydralazine
- Clonidine
- Doxazosin
Correct answer: Amlodipine
Amlodipine, a long-acting dihydropyridine calcium channel blocker, effectively reduces blood pressure and angina episodes and has demonstrated cardiovascular outcome benefits.
Question 6: A patient stabilized on warfarin for DVT is started on amiodarone for atrial fibrillation. What is the expected pharmacokinetic interaction?
- Amiodarone inhibits CYP2C9, increasing warfarin levels and INR (Correct answer)
- Amiodarone induces CYP2C9, decreasing warfarin levels
- Amiodarone displaces warfarin from protein binding, temporarily decreasing INR
- No clinically significant interaction exists
Correct answer: Amiodarone inhibits CYP2C9, increasing warfarin levels and INR
Amiodarone potently inhibits CYP2C9 (and CYP3A4), reducing warfarin metabolism and significantly increasing INR, often requiring a 30-50% warfarin dose reduction.
Question 7: Which combination of antihypertensive agents is generally avoided due to the highest risk of acute kidney injury and hyperkalemia?
- ACE inhibitor plus ARB (Correct answer)
- ACE inhibitor plus calcium channel blocker
- ARB plus thiazide diuretic
- Beta-blocker plus calcium channel blocker
Correct answer: ACE inhibitor plus ARB
Dual RAAS blockade with an ACE inhibitor plus ARB significantly increases the risk of hypotension, hyperkalemia, and acute kidney injury without added cardiovascular benefit over monotherapy.
BCACP Cardiovascular Disease Management 2
A patient with heart failure with reduced ejection fraction (HFrEF) and CKD stage 3b (eGFR 32 mL/min) is started on sacubitril/valsartan.
Which monitoring parameter is most critical in the first month?