BCACP Hypertension and Dyslipidemia Therapy 2 — Questions and Answers
Question 1: A patient with stage 2 hypertension and CKD (eGFR 35 mL/min) is started on lisinopril 10 mg daily. Two weeks later, serum creatinine rises 25% from baseline. What is the most appropriate next step?
- Discontinue lisinopril immediately
- Continue lisinopril; a <30% creatinine rise is acceptable (Correct answer)
- Switch to amlodipine
- Reduce lisinopril dose by half and recheck in 1 week
Correct answer: Continue lisinopril; a <30% creatinine rise is acceptable
An increase in serum creatinine up to 30% above baseline after initiating an ACE inhibitor is acceptable and expected due to reduced glomerular efferent vasoconstriction.
Question 2: Which antihypertensive drug class is most associated with causing hyperkalemia in patients with CKD?
- Calcium channel blockers
- Thiazide diuretics
- ACE inhibitors (Correct answer)
- Alpha-1 blockers
Correct answer: ACE inhibitors
ACE inhibitors block angiotensin II–mediated aldosterone release, reducing potassium excretion and predisposing CKD patients to hyperkalemia.
Question 3: A patient on rosuvastatin 20 mg develops unexplained muscle pain. CK is 12,000 U/L. What is the most appropriate action?
- Reduce rosuvastatin to 10 mg
- Switch to pravastatin 40 mg
- Discontinue rosuvastatin immediately (Correct answer)
- Add CoQ10 and continue rosuvastatin
Correct answer: Discontinue rosuvastatin immediately
Markedly elevated CK (>10× ULN) with muscle symptoms indicates myopathy/rhabdomyolysis and requires immediate statin discontinuation.
Question 4: According to ACC/AHA guidelines, which patient qualifies for high-intensity statin therapy based on ASCVD risk alone?
- 45-year-old with LDL 130 mg/dL and 7% 10-year risk
- 60-year-old with established ASCVD (Correct answer)
- 55-year-old diabetic with LDL 95 mg/dL
- 35-year-old with LDL 160 mg/dL and family history
Correct answer: 60-year-old with established ASCVD
Established ASCVD is a primary indication for high-intensity statin therapy regardless of baseline LDL.
Question 5: A pregnant patient in her first trimester is found to have a BP of 158/102 mmHg. Which antihypertensive is CONTRAINDICATED?
- Labetalol
- Nifedipine XL
- Methyldopa
- Lisinopril (Correct answer)
Correct answer: Lisinopril
ACE inhibitors are contraindicated in pregnancy due to risk of fetal renal dysgenesis, oligohydramnios, and neonatal renal failure.
Question 6: Ezetimibe lowers LDL primarily through which mechanism?
- Inhibiting HMG-CoA reductase in the liver
- Blocking bile acid reabsorption in the gut
- Inhibiting cholesterol absorption in the small intestine via NPC1L1 (Correct answer)
- Activating PPAR-alpha to enhance lipolysis
Correct answer: Inhibiting cholesterol absorption in the small intestine via NPC1L1
Ezetimibe selectively inhibits the NPC1L1 transporter on intestinal enterocytes, reducing cholesterol absorption and lowering LDL.
Question 7: A patient is on amlodipine 10 mg and lisinopril 20 mg but BP remains 150/92 mmHg. Which add-on therapy is most guideline-supported for a third-line agent?
- Clonidine
- Chlorthalidone (Correct answer)
- Doxazosin
- Hydralazine
Correct answer: Chlorthalidone
JNC and ACC/AHA guidelines recommend a thiazide-type diuretic (preferably chlorthalidone) as the third drug in a three-drug combination regimen for resistant hypertension.
BCACP Hypertension and Dyslipidemia Therapy 2
A patient with stage 2 hypertension and CKD (eGFR 35 mL/min) is started on lisinopril 10 mg daily.
Two weeks later, serum creatinine rises 25% from baseline.
What is the most appropriate next step?