BCACP Cardiovascular Disease Management 5

Question 1

A patient with hypertension and gout is currently on hydrochlorothiazide 25 mg daily. His uric acid is 9.8 mg/dL and he just had a gout flare. What antihypertensive change is most appropriate?

Accepted Answer

Switch to losartan, which has uricosuric properties

Answer

Losartan is the preferred ARB in hypertensive patients with gout because it has modest uricosuric properties that can lower serum uric acid, unlike other antihypertensives.

Question 2

A patient is initiated on colchicine 0.5 mg BID for recurrent pericarditis and is also taking atorvastatin and clarithromycin for a respiratory infection. What is the primary concern?

Accepted Answer

Clarithromycin inhibits CYP3A4 and P-gp, increasing colchicine toxicity risk

Answer

Clarithromycin is a potent CYP3A4 and P-glycoprotein inhibitor that dramatically increases colchicine plasma levels, potentially causing life-threatening colchicine toxicity including bone marrow suppression.

Question 3

A patient with resistant hypertension (BP 158/96 mmHg on maximally tolerated doses of ACE inhibitor, calcium channel blocker, and thiazide diuretic) is being evaluated. What is the most appropriate add-on agent?

Accepted Answer

Spironolactone

Answer

Spironolactone is the preferred 4th-line agent for resistant hypertension, as mineralocorticoid excess is common in this population and spironolactone has demonstrated superior BP reduction over other add-on agents in trials like PATHWAY-2.

Question 4

A patient with HFpEF (EF 60%) presents with volume overload. Which pharmacologic intervention has the most robust evidence for reducing hospitalizations specifically in HFpEF?

Accepted Answer

SGLT2 inhibitors (empagliflozin or dapagliflozin)

Answer

SGLT2 inhibitors (empagliflozin in EMPEROR-Preserved, dapagliflozin in DELIVER) have demonstrated statistically significant reductions in heart failure hospitalizations in HFpEF, unlike ACE inhibitors and beta-blockers which lack this evidence.

Question 5

A 58-year-old post-MI patient on aspirin 81 mg and clopidogrel asks about taking ibuprofen for arthritis pain. What is the pharmacist's primary concern?

Accepted Answer

Ibuprofen competitively inhibits the COX-1 binding site, blocking aspirin's irreversible antiplatelet effect

Answer

Ibuprofen (and other NSAIDs) reversibly occupy the COX-1 active site, sterically blocking aspirin's irreversible acetylation, thereby attenuating aspirin's antiplatelet efficacy if taken before aspirin.

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP Cardiovascular Disease Management 5