BCACP Cardiovascular Risk Reduction 5 — Questions and Answers
Question 1: A patient with peripheral artery disease (ABI = 0.75) and hypertension needs antihypertensive therapy. Which drug class is NOT contraindicated in PAD and can be used safely?
- Beta-blockers
- ACE inhibitors
- Calcium channel blockers
- All of the above (Correct answer)
Correct answer: All of the above
All major antihypertensive classes including ACE inhibitors, CCBs, and beta-blockers can be used in PAD; the priority is achieving BP control.
Question 2: A patient taking clopidogrel after coronary stent placement is prescribed omeprazole for GI protection. What is the main pharmacokinetic concern?
- Omeprazole increases clopidogrel absorption
- Omeprazole inhibits CYP2C19 reducing clopidogrel activation (Correct answer)
- Omeprazole accelerates clopidogrel elimination
- No clinically significant interaction exists
Correct answer: Omeprazole inhibits CYP2C19 reducing clopidogrel activation
Omeprazole inhibits CYP2C19, the enzyme responsible for converting clopidogrel to its active metabolite, potentially reducing antiplatelet efficacy.
Question 3: Which lifestyle intervention has the MOST evidence for reducing LDL-C without medication?
- Increasing aerobic exercise
- Reducing dietary saturated fat (Correct answer)
- Increasing dietary fiber
- Limiting alcohol intake
Correct answer: Reducing dietary saturated fat
Reducing dietary saturated fat has the strongest evidence for lowering LDL-C among lifestyle interventions, replacing it with unsaturated fats provides additional benefit.
Question 4: In a patient with HFrEF on optimal medical therapy, which medication class has been shown to reduce hospitalizations and mortality with a unique mechanism involving sodium-hydrogen exchange inhibition?
- ARNIs
- SGLT2 inhibitors (Correct answer)
- Ivabradine
- Hydralazine-nitrate
Correct answer: SGLT2 inhibitors
SGLT2 inhibitors (empagliflozin, dapagliflozin) reduce HF hospitalizations and CV mortality in HFrEF via osmotic diuresis and cardiac effects.
Question 5: A patient is prescribed sacubitril/valsartan for HFrEF. What is the required washout period before starting this drug if the patient was previously taking an ACE inhibitor?
- 12 hours
- 24 hours
- 36 hours (Correct answer)
- 48 hours
Correct answer: 36 hours
A 36-hour washout period is required after stopping an ACE inhibitor before starting sacubitril/valsartan to prevent life-threatening angioedema.
Question 6: Which antithrombotic strategy is recommended for a patient 12 months after drug-eluting stent placement who has a low bleeding risk?
- Dual antiplatelet therapy indefinitely
- Aspirin monotherapy only (Correct answer)
- Transition to anticoagulation alone
- Discontinue all antithrombotic therapy
Correct answer: Aspirin monotherapy only
After 12 months of DAPT post-DES in stable patients, guidelines recommend transitioning to aspirin monotherapy for long-term secondary prevention.
Question 7: A patient with resistant hypertension (BP uncontrolled on 3 medications including a diuretic) is being evaluated. Which additional agent should be considered as fourth-line therapy?
- Doxazosin
- Spironolactone (Correct answer)
- Clonidine
- Hydralazine
Correct answer: Spironolactone
Spironolactone is recommended as fourth-line therapy for resistant hypertension based on evidence from the PATHWAY-2 trial showing superior BP reduction.
BCACP Cardiovascular Risk Reduction 5
A patient with peripheral artery disease (ABI = 0.75) and hypertension needs antihypertensive therapy.
Which drug class is NOT contraindicated in PAD and can be used safely?