BCACP Hypertension and Dyslipidemia Therapy 4

Question 1

Which fibrate carries the lowest risk of myopathy when used in combination with a statin?

Accepted Answer

Fenofibrate

Answer

Fenofibrate does not inhibit glucuronidation of statins (unlike gemfibrozil) and therefore carries a significantly lower risk of statin-associated myopathy.

Question 2

A patient on lisinopril develops a dry cough. The pharmacist recommends switching to which medication?

Accepted Answer

Losartan

Answer

ACE inhibitor–induced cough (due to bradykinin accumulation) is a class effect; ARBs such as losartan do not affect bradykinin and are the preferred switch.

Question 3

What is the primary mechanism by which spironolactone lowers blood pressure in resistant hypertension?

Accepted Answer

Aldosterone receptor antagonism promoting sodium excretion

Answer

Spironolactone blocks mineralocorticoid receptors, preventing aldosterone-mediated sodium and water retention, which is particularly effective in patients with elevated aldosterone levels.

Question 4

Colesevelam (a bile acid sequestrant) is unique among lipid-lowering agents because it also reduces which other cardiovascular risk marker?

Accepted Answer

Hemoglobin A1c in type 2 diabetes

Answer

Colesevelam has FDA approval for improving glycemic control in type 2 diabetes, making it a dual-benefit agent in diabetic patients with dyslipidemia.

Question 5

A patient with hypertension and a history of angioedema on enalapril is started on sacubitril/valsartan for HFrEF. What important counseling point applies?

Accepted Answer

Sacubitril/valsartan is contraindicated in patients with prior ACE inhibitor angioedema

Answer

A history of ACE inhibitor–induced angioedema is a contraindication to sacubitril/valsartan because neprilysin inhibition further raises bradykinin levels, increasing angioedema risk.

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP Hypertension and Dyslipidemia Therapy 4