BCACP Hypertension and Dyslipidemia Therapy 3 — Questions and Answers
Question 1: Which PCSK9 inhibitor is FDA-approved as a twice-yearly subcutaneous injection for LDL reduction?
- Evolocumab
- Alirocumab
- Inclisiran (Correct answer)
- Bempedoic acid
Correct answer: Inclisiran
Inclisiran is an siRNA that inhibits PCSK9 synthesis and is dosed subcutaneously at baseline, 3 months, then every 6 months.
Question 2: A patient with hypertension and gout flares is on hydrochlorothiazide. What is the most appropriate change?
- Add allopurinol and continue HCTZ
- Switch to chlorthalidone
- Switch to losartan (Correct answer)
- Switch to furosemide
Correct answer: Switch to losartan
Losartan has a uricosuric effect that makes it the preferred antihypertensive in patients with gout, and switching from a thiazide reduces uric acid elevation.
Question 3: Which lipid-lowering drug is most associated with flushing as a side effect and requires premedication with aspirin?
- Fenofibrate
- Niacin (nicotinic acid) (Correct answer)
- Ezetimibe
- Colesevelam
Correct answer: Niacin (nicotinic acid)
Niacin causes prostaglandin-mediated cutaneous flushing; taking 325 mg aspirin 30 minutes before the dose significantly reduces this effect.
Question 4: A 70-year-old patient is on simvastatin 40 mg and is newly started on amlodipine. What drug interaction concern exists?
- Amlodipine reduces simvastatin efficacy
- Amlodipine inhibits CYP3A4 and increases simvastatin exposure (Correct answer)
- No clinically significant interaction exists
- Amlodipine displaces simvastatin from plasma proteins
Correct answer: Amlodipine inhibits CYP3A4 and increases simvastatin exposure
Amlodipine weakly inhibits CYP3A4 and can modestly increase simvastatin plasma levels, potentially increasing myopathy risk.
Question 5: According to ACC/AHA guidelines, what is the LDL goal for a very high-risk ASCVD patient on maximally tolerated statin therapy?
- <100 mg/dL
- <70 mg/dL
- <55 mg/dL (Correct answer)
- <40 mg/dL
Correct answer: <55 mg/dL
For very high-risk ASCVD patients (multiple major events or one major event plus multiple high-risk conditions), the 2022 ACC/AHA guidelines suggest an LDL goal of <55 mg/dL.
Question 6: Which antihypertensive is the preferred choice in a patient with hypertension and heart failure with reduced ejection fraction (HFrEF)?
- Amlodipine
- Carvedilol (Correct answer)
- Diltiazem
- Clonidine
Correct answer: Carvedilol
Carvedilol, a non-selective beta-blocker with alpha-1 blocking activity, is a guideline-directed medical therapy for HFrEF and also lowers blood pressure.
Question 7: A patient with hypertension and bilateral renal artery stenosis is being considered for antihypertensive therapy. Which drug class should be AVOIDED?
- Calcium channel blockers
- Alpha-blockers
- ACE inhibitors (Correct answer)
- Thiazide diuretics
Correct answer: ACE inhibitors
ACE inhibitors in bilateral renal artery stenosis can precipitate acute renal failure by eliminating angiotensin II–dependent efferent arteriolar tone, the only mechanism maintaining filtration pressure.
BCACP Hypertension and Dyslipidemia Therapy 3
Which PCSK9 inhibitor is FDA-approved as a twice-yearly subcutaneous injection for LDL reduction?