BCPS BCPS Cardiovascular & Critical Care Pharmacotherapy 3

Question 1

A patient with acute decompensated heart failure and cardiogenic shock is started on dobutamine. What is the primary mechanism of action and expected hemodynamic effect?

Accepted Answer

Beta-1 agonist causing positive inotropy and increased cardiac output

Answer

Alpha-1 agonist causing peripheral vasoconstriction and increased SVR

Answer

Phosphodiesterase inhibitor causing arterial and venous dilation

Answer

Beta-2 agonist causing bronchodilation without cardiac effect

Question 2

A patient is in torsades de pointes (TdP), a polymorphic ventricular tachycardia associated with a prolonged QTc interval. What is the immediate treatment of choice?

Accepted Answer

IV magnesium sulfate 1–2 g over 5–10 minutes

Answer

IV amiodarone 150 mg bolus

Answer

IV lidocaine 1–1.5 mg/kg

Answer

Synchronized cardioversion immediately

Question 3

Which ACE inhibitor indication requires careful monitoring of serum potassium, particularly when combined with an aldosterone antagonist such as spironolactone?

Accepted Answer

Heart failure with reduced ejection fraction

Answer

Treatment of uncomplicated hypertension

Answer

Prophylaxis of migraine headaches

Answer

Treatment of atrial fibrillation

Question 4

A patient is admitted with a non-ST-elevation myocardial infarction (NSTEMI). Which antiplatelet agent provides faster, more potent platelet inhibition compared to clopidogrel and does not require hepatic activation?

Accepted Answer

Ticagrelor

Answer

Aspirin

Answer

Prasugrel

Answer

Vorapaxar

Question 5

In a critically ill patient receiving propofol infusion for sedation, which serious metabolic complication must be monitored, especially with doses >4 mg/kg/hr for >48 hours?

Accepted Answer

Propofol infusion syndrome (PRIS) — metabolic acidosis, rhabdomyolysis, cardiac failure

Answer

Hypoglycemia

Answer

Hypernatremia from sodium content

Answer

Severe hypertension from sympathomimetic effects

Question 6

Which beta-blocker property is most important when selecting an agent for a patient with HFrEF, and which three agents have proven mortality benefit in clinical trials?

Accepted Answer

Beta-1 selectivity or combined alpha/beta blockade without ISA; carvedilol, metoprolol succinate, bisoprolol

Answer

Intrinsic sympathomimetic activity (ISA); metoprolol, atenolol, propranolol

Answer

Lipophilicity for CNS penetration; propranolol, labetalol, pindolol

Answer

Short half-life for flexible dosing; esmolol, acebutolol, timolol