BCACP Hypertension and Dyslipidemia Therapy 5 — Questions and Answers
Question 1: A patient on atorvastatin 40 mg has LDL of 85 mg/dL but is very high-risk ASCVD. After maximizing statin dose, which add-on therapy should be considered first per ACC/AHA guidelines?
- Niacin
- Ezetimibe (Correct answer)
- Fenofibrate
- Colesevelam
Correct answer: Ezetimibe
ACC/AHA guidelines recommend adding ezetimibe as the first non-statin therapy in very high-risk patients whose LDL remains above goal on maximally tolerated statin therapy.
Question 2: Which antihypertensive drug class is the recommended first-line therapy for a patient with hypertension and proteinuric diabetic nephropathy?
- Calcium channel blockers
- Beta-blockers
- ACE inhibitors or ARBs (Correct answer)
- Thiazide diuretics
Correct answer: ACE inhibitors or ARBs
ACE inhibitors and ARBs reduce intraglomerular pressure and proteinuria in diabetic nephropathy, providing renoprotection beyond blood pressure lowering.
Question 3: A patient taking simvastatin 80 mg is newly prescribed clarithromycin for a respiratory infection. What is the most appropriate pharmacist intervention?
- Counsel patient to watch for muscle pain but continue both drugs
- Hold simvastatin during the 5-day antibiotic course (Correct answer)
- Reduce simvastatin to 40 mg for the antibiotic duration
- Switch clarithromycin to azithromycin to avoid the interaction
Correct answer: Hold simvastatin during the 5-day antibiotic course
Clarithromycin is a potent CYP3A4 inhibitor that dramatically increases simvastatin exposure; holding the statin for the short antibiotic course is the recommended strategy.
Question 4: Hypertriglyceridemia (TG >500 mg/dL) poses what primary acute risk that warrants immediate treatment?
- Acute coronary syndrome
- Acute pancreatitis (Correct answer)
- Ischemic stroke
- Venous thromboembolism
Correct answer: Acute pancreatitis
Severely elevated triglycerides (>500 mg/dL) increase the risk of acute pancreatitis, which is the primary reason for urgent pharmacologic intervention at this level.
Question 5: Which antihypertensive drug is preferred in a patient with hypertension and a concurrent migraine prophylaxis indication?
- Amlodipine
- Propranolol (Correct answer)
- Losartan
- Chlorthalidone
Correct answer: Propranolol
Propranolol is FDA-approved for migraine prophylaxis and also lowers blood pressure, making it an ideal single-agent choice for patients with both conditions.
Question 6: A patient on warfarin is started on cholestyramine for LDL reduction. Which counseling point is most critical?
- Cholestyramine doubles warfarin efficacy
- Cholestyramine should be taken at the same time as warfarin
- Warfarin should be taken 1 hour before or 4-6 hours after cholestyramine (Correct answer)
- No interaction exists; both drugs can be taken together
Correct answer: Warfarin should be taken 1 hour before or 4-6 hours after cholestyramine
Bile acid sequestrants bind warfarin in the GI tract, reducing its absorption; separating administration by at least 4-6 hours (or taking warfarin 1 hour before) preserves anticoagulation.
Question 7: Which of the following represents the correct ACC/AHA classification of a patient with a sustained BP of 138/88 mmHg on two separate visits?
- Normal BP
- Elevated BP
- Stage 1 hypertension (Correct answer)
- Stage 2 hypertension
Correct answer: Stage 1 hypertension
Per 2017 ACC/AHA guidelines, stage 1 hypertension is defined as SBP 130–139 mmHg or DBP 80–89 mmHg, so 138/88 falls in this category.
BCACP Hypertension and Dyslipidemia Therapy 5
A patient on atorvastatin 40 mg has LDL of 85 mg/dL but is very high-risk ASCVD.
After maximizing statin dose, which add-on therapy should be considered first per ACC/AHA guidelines?