CSC CSC Pharmacology & Treatment Protocols 1 — Questions and Answers
Question 1: Which medication class is first-line for managing symptomatic heart failure with reduced ejection fraction (HFrEF)?
- Calcium channel blockers
- ACE inhibitors or ARBs plus beta-blockers (Correct answer)
- Loop diuretics alone
- Digoxin alone
Correct answer: ACE inhibitors or ARBs plus beta-blockers
ACE inhibitors (or ARBs) combined with beta-blockers form the cornerstone of guideline-directed medical therapy for HFrEF, reducing mortality and hospitalizations.
Question 2: Adenosine is used in cardiac stress testing primarily because it:
- Increases heart rate and blood pressure
- Causes coronary vasodilation, revealing perfusion differences (Correct answer)
- Stabilizes atrial fibrillation
- Reverses beta-blocker effects
Correct answer: Causes coronary vasodilation, revealing perfusion differences
Adenosine produces maximal coronary vasodilation, creating a 'steal' effect that unmasks perfusion heterogeneity in the presence of coronary artery disease.
Question 3: Anticoagulation with warfarin requires monitoring via:
- aPTT (activated partial thromboplastin time)
- INR (International Normalized Ratio) (Correct answer)
- Anti-Xa levels
- Platelet count
Correct answer: INR (International Normalized Ratio)
Warfarin's anticoagulant effect is monitored using the INR, which standardizes prothrombin time measurements across laboratories.
Question 4: Beta-blockers are contraindicated in acute decompensated heart failure because they:
- Increase systemic vascular resistance
- Reduce the heart's ability to compensate via increased heart rate (Correct answer)
- Cause hyperkalemia
- Induce torsades de pointes
Correct answer: Reduce the heart's ability to compensate via increased heart rate
In acute decompensated heart failure, the sympathetic nervous system's compensatory tachycardia is critical; beta-blockers blunt this response and can worsen hemodynamics.
Question 5: Heparin anticoagulation during cardiac catheterization is monitored with:
- INR
- Activated clotting time (ACT) (Correct answer)
- Anti-Xa level
- Thrombin time
Correct answer: Activated clotting time (ACT)
Activated clotting time (ACT) is used intraprocedurallyto monitor unfractionated heparin during cardiac catheterization and PCI, targeting ACT 250–350 seconds.
Question 6: Nitroglycerin reduces cardiac workload primarily by:
- Increasing heart rate
- Decreasing preload through venodilation (Correct answer)
- Blocking beta-adrenergic receptors
- Increasing myocardial contractility
Correct answer: Decreasing preload through venodilation
Nitroglycerin predominantly causes venodilation, reducing venous return and preload, which decreases myocardial oxygen demand and wall tension.
CSC CSC Pharmacology & Treatment Protocols 1
Which medication class is first-line for managing symptomatic heart failure with reduced ejection fraction (HFrEF)?