BCACP Cardiovascular Disease Management 3 — Questions and Answers
Question 1: A patient with type 2 diabetes and established ASCVD has an A1c of 8.2%. Which antidiabetic agent provides the greatest cardiovascular mortality benefit in this scenario?
- Empagliflozin or liraglutide (Correct answer)
- Glipizide
- Pioglitazone
- Sitagliptin
Correct answer: Empagliflozin or liraglutide
SGLT2 inhibitors (empagliflozin) and GLP-1 receptor agonists (liraglutide) have demonstrated cardiovascular mortality reduction in patients with T2DM and established ASCVD in landmark trials.
Question 2: A patient on aspirin 81 mg daily for secondary prevention develops a GI bleed. After recovery, what is the most appropriate management of antiplatelet therapy?
- Resume aspirin with a proton pump inhibitor (Correct answer)
- Switch to clopidogrel without a PPI
- Discontinue all antiplatelet therapy permanently
- Switch to dipyridamole monotherapy
Correct answer: Resume aspirin with a proton pump inhibitor
Aspirin should be resumed for secondary cardiovascular prevention with concomitant PPI therapy to reduce recurrent GI bleeding risk, as the cardiovascular benefit outweighs GI risk when managed appropriately.
Question 3: What is the mechanism by which ivabradine reduces symptoms in stable heart failure with reduced ejection fraction?
- Selectively inhibits the If (funny) current in the SA node, reducing heart rate (Correct answer)
- Blocks beta-1 receptors in the myocardium
- Inhibits calcium channels in vascular smooth muscle
- Increases vagal tone through muscarinic receptor activation
Correct answer: Selectively inhibits the If (funny) current in the SA node, reducing heart rate
Ivabradine selectively inhibits the If current in the sinoatrial node, slowing heart rate without affecting myocardial contractility or blood pressure.
Question 4: A patient with peripheral arterial disease (PAD) and hypertension asks if beta-blockers are contraindicated. What is the most accurate response?
- Beta-blockers are not contraindicated in PAD and may be used when indicated for comorbidities (Correct answer)
- Beta-blockers are absolutely contraindicated in all PAD patients
- Only non-selective beta-blockers are contraindicated in PAD
- Beta-blockers must be avoided if the ABI is below 0.9
Correct answer: Beta-blockers are not contraindicated in PAD and may be used when indicated for comorbidities
Current evidence does not support avoiding beta-blockers in PAD; they are indicated for comorbid conditions such as CAD, HF, or post-MI and do not worsen claudication significantly.
Question 5: A patient with HFrEF and iron-deficiency anemia (ferritin <100 ng/mL, transferrin saturation <20%) is being optimized. Which intervention has demonstrated improved symptoms and quality of life?
- Intravenous ferric carboxymaltose (Correct answer)
- Oral ferrous sulfate
- Erythropoiesis-stimulating agents
- Blood transfusion
Correct answer: Intravenous ferric carboxymaltose
Intravenous ferric carboxymaltose has demonstrated improved exercise capacity, symptoms, and quality of life in HFrEF patients with iron deficiency, unlike oral iron which has shown limited benefit.
Question 6: A 55-year-old patient is prescribed spironolactone 25 mg daily for HFrEF. His current medications include lisinopril 10 mg and carvedilol 6.25 mg BID. Which baseline laboratory value must be checked before initiating spironolactone?
- Serum creatinine and potassium (Correct answer)
- Serum sodium and magnesium
- Liver function tests and albumin
- Complete metabolic panel and CBC
Correct answer: Serum creatinine and potassium
Spironolactone can cause life-threatening hyperkalemia, especially combined with an ACE inhibitor, and can worsen renal function; baseline creatinine and potassium must be assessed and monitored.
Question 7: A patient newly diagnosed with hypertension has a blood pressure of 158/96 mmHg and no compelling indications. According to ACC/AHA guidelines, what is the preferred initial therapy?
- A thiazide diuretic, ACE inhibitor/ARB, or calcium channel blocker (Correct answer)
- An ARB plus a thiazide diuretic combination
- A beta-blocker as first-line monotherapy
- Alpha-blocker monotherapy
Correct answer: A thiazide diuretic, ACE inhibitor/ARB, or calcium channel blocker
ACC/AHA guidelines recommend thiazide diuretics, ACE inhibitors/ARBs, or long-acting calcium channel blockers as first-line options for hypertension without compelling indications.
BCACP Cardiovascular Disease Management 3
A patient with type 2 diabetes and established ASCVD has an A1c of 8.2%.
Which antidiabetic agent provides the greatest cardiovascular mortality benefit in this scenario?