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

Dobutamine is a selective beta-1 adrenergic agonist that increases myocardial contractility and cardiac output, making it the inotrope of choice in cardiogenic shock.

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 magnesium sulfate is the immediate treatment of choice for TdP because it stabilizes cardiac membranes and terminates the arrhythmia regardless of serum magnesium levels.

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

ACE inhibitors combined with aldosterone antagonists in HFrEF create additive potassium-retaining effects requiring close monitoring for life-threatening hyperkalemia.

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

Ticagrelor is a direct-acting, reversible P2Y12 inhibitor that does not require hepatic bioactivation, providing faster and more consistent platelet inhibition than the prodrug clopidogrel.

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

Propofol infusion syndrome (PRIS) is a rare but potentially fatal complication of high-dose or prolonged propofol infusions, presenting with metabolic acidosis, rhabdomyolysis, and cardiac failure.

(BCPS) Board Certified Pharmacotherapy Specialist Practice Test

(BCPS) Board Certified Pharmacotherapy Specialist Practice Test

BCPS BCPS Cardiovascular & Critical Care Pharmacotherapy 3