BCACP Cardiovascular Disease Management 4

Question 1

A patient with non-valvular atrial fibrillation and CrCl of 28 mL/min requires anticoagulation. Which DOAC is preferred and at what dose adjustment?

Accepted Answer

Apixaban 2.5 mg BID (if age ≥80, weight ≤60 kg, or SCr ≥1.5 mg/dL—at least 2 criteria met)

Answer

Apixaban is preferred in severe CKD and ESRD due to the least renal elimination (~27%), with dose reduction to 2.5 mg BID when at least 2 of 3 criteria are met (age ≥80, weight ≤60 kg, SCr ≥1.5).

Question 2

A 62-year-old male patient with a recent STEMI is discharged on dual antiplatelet therapy (aspirin + ticagrelor). When should aspirin be taken relative to ticagrelor to avoid reduced efficacy?

Accepted Answer

Aspirin doses should be limited to ≤100 mg/day; high-dose aspirin blunts ticagrelor's antiplatelet effect

Answer

High-dose aspirin (>100 mg/day) paradoxically attenuates ticagrelor's antiplatelet effect by blocking prostacyclin synthesis; aspirin should be maintained at ≤100 mg/day.

Question 3

A patient with HFrEF, EF 30%, NYHA class II, already on optimal medical therapy including an ACE inhibitor, beta-blocker, and aldosterone antagonist, has an EKG showing LBBB with QRS duration of 158 ms. What additional therapy should be recommended?

Accepted Answer

Cardiac resynchronization therapy (CRT)

Answer

CRT is indicated in HFrEF patients with EF ≤35%, NYHA class II-IV on optimal medical therapy with LBBB and QRS ≥150 ms, as it improves symptoms, EF, and reduces mortality.

Question 4

A pharmacist reviews a patient's chart and notes that 3 days post-STEMI, the patient's troponin is still elevated. The prescriber asks about starting a statin. What is the correct recommendation?

Accepted Answer

Start high-intensity statin immediately regardless of baseline LDL-C

Answer

High-intensity statin therapy should be initiated as early as possible after ACS regardless of baseline LDL-C levels, as statins provide pleiotropic benefits beyond LDL lowering in this acute setting.

Question 5

A patient taking diltiazem for rate control in atrial fibrillation is started on simvastatin 40 mg. What is the most significant drug interaction concern?

Accepted Answer

Diltiazem inhibits CYP3A4, increasing simvastatin exposure and risk of myopathy/rhabdomyolysis

Answer

Diltiazem is a moderate CYP3A4 inhibitor that increases simvastatin plasma concentrations significantly, raising the risk of myopathy and rhabdomyolysis; dose should be capped or a non-CYP3A4-metabolized statin used.

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP Cardiovascular Disease Management 4