BCPS BCPS Cardiovascular & Critical Care Pharmacotherapy 1 — Questions and Answers
Question 1: A patient with heart failure with reduced ejection fraction (HFrEF, EF 30%) is already on carvedilol and lisinopril. Which additional agent has been shown to reduce mortality and hospitalizations in this population?
- Digoxin
- Amlodipine
- Sacubitril/valsartan (Entresto) (Correct answer)
- Ivabradine as first addition
Correct answer: Sacubitril/valsartan (Entresto)
Sacubitril/valsartan (ARNI) demonstrated superior reduction in cardiovascular death and HF hospitalization compared to enalapril in the PARADIGM-HF trial and is recommended for HFrEF.
Question 2: A patient in the ICU develops atrial fibrillation with rapid ventricular response and is hemodynamically stable. Which agent is preferred for acute rate control?
- Amiodarone IV
- Diltiazem IV (Correct answer)
- Digoxin IV
- Adenosine IV
Correct answer: Diltiazem IV
IV diltiazem (non-dihydropyridine CCB) is preferred for acute rate control in hemodynamically stable AF because of its rapid onset and titratable effect.
Question 3: Which vasopressor is considered first-line for septic shock per Surviving Sepsis Campaign guidelines?
- Epinephrine
- Dopamine
- Norepinephrine (Correct answer)
- Phenylephrine
Correct answer: Norepinephrine
Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis Campaign guidelines due to its strong alpha-1 activity with less tachycardia compared to dopamine.
Question 4: A patient with STEMI undergoes PCI and is started on dual antiplatelet therapy (DAPT) with aspirin and ticagrelor. Which monitoring parameter is specifically important for ticagrelor?
- Complete blood count weekly for thrombocytopenia
- Serum potassium for hyperkalemia
- Dyspnea (often off-target adenosine effect) and bleeding (Correct answer)
- Liver function tests monthly
Correct answer: Dyspnea (often off-target adenosine effect) and bleeding
Ticagrelor causes dyspnea in up to 15% of patients (via adenosine pathway) and significantly increases bleeding risk, requiring monitoring of both.
Question 5: A patient is in hypertensive emergency with a blood pressure of 220/130 mmHg and new onset confusion. What is the correct initial blood pressure reduction target within the first hour?
- Reduce to normal (<120/80 mmHg) as quickly as possible
- Reduce mean arterial pressure (MAP) by no more than 25% in the first hour (Correct answer)
- Reduce systolic BP to below 160 mmHg within 15 minutes
- Reduce diastolic BP to below 90 mmHg within 30 minutes
Correct answer: Reduce mean arterial pressure (MAP) by no more than 25% in the first hour
Over-rapid BP reduction in hypertensive emergency can cause ischemia; guidelines recommend reducing MAP by no more than 25% in the first hour.
Question 6: Which anticoagulant is preferred for heparin-induced thrombocytopenia (HIT) and why?
- Low molecular weight heparin (enoxaparin)
- Warfarin with immediate bridging
- A direct thrombin inhibitor such as argatroban or bivalirudin (Correct answer)
- Fondaparinux as the only option
Correct answer: A direct thrombin inhibitor such as argatroban or bivalirudin
Direct thrombin inhibitors (argatroban, bivalirudin) do not cross-react with HIT antibodies and are the preferred anticoagulants once HIT is diagnosed.
BCPS BCPS Cardiovascular & Critical Care Pharmacotherapy 1
A patient with heart failure with reduced ejection fraction (HFrEF, EF 30%) is already on carvedilol and lisinopril.
Which additional agent has been shown to reduce mortality and hospitalizations in this population?