BCPS BCPS Cardiovascular & Specialty Pharmacotherapy 1 — Questions and Answers
Question 1: Which antihypertensive drug class is the preferred first-line agent for hypertension in patients with chronic kidney disease (CKD) and proteinuria?
- Calcium channel blockers
- Beta-blockers
- ACE inhibitors or ARBs (Correct answer)
- Thiazide diuretics
Correct answer: ACE inhibitors or ARBs
ACE inhibitors and ARBs reduce intraglomerular pressure and proteinuria, providing renoprotective benefits beyond blood pressure lowering in CKD.
Question 2: A patient with heart failure with reduced ejection fraction (HFrEF) is already on an ACE inhibitor, beta-blocker, and loop diuretic. Which additional agent has been shown to further reduce mortality?
- Amlodipine
- Hydralazine monotherapy
- Spironolactone (Correct answer)
- Digoxin
Correct answer: Spironolactone
Mineralocorticoid receptor antagonists (MRAs) such as spironolactone have demonstrated significant mortality reduction in HFrEF patients in the RALES trial.
Question 3: Which anticoagulant requires monitoring with anti-Xa levels rather than aPTT when used therapeutically?
- Unfractionated heparin (UFH)
- Low molecular weight heparin (LMWH) (Correct answer)
- Warfarin
- Argatroban
Correct answer: Low molecular weight heparin (LMWH)
LMWH (e.g., enoxaparin) does not reliably prolong aPTT and is monitored with anti-Xa levels when monitoring is needed (e.g., extremes of weight, renal impairment).
Question 4: A patient with atrial fibrillation (AF) and a CHA₂DS₂-VASc score of 3 requires anticoagulation. Which agent is preferred over warfarin per current guidelines?
- Aspirin 325 mg daily
- Direct oral anticoagulants (DOACs) such as apixaban or rivaroxaban (Correct answer)
- Warfarin with target INR 2-3
- Clopidogrel plus aspirin
Correct answer: Direct oral anticoagulants (DOACs) such as apixaban or rivaroxaban
DOACs are preferred over warfarin for stroke prevention in nonvalvular AF due to superior efficacy, safety, and the absence of routine INR monitoring.
Question 5: Which lipid-lowering agent is the drug of choice for lowering triglycerides and raising HDL cholesterol in a patient with isolated hypertriglyceridemia (TG 500-1000 mg/dL)?
- High-intensity statin
- Ezetimibe
- Fibrates (e.g., fenofibrate) (Correct answer)
- Niacin
Correct answer: Fibrates (e.g., fenofibrate)
Fibrates are the drug of choice for severe hypertriglyceridemia because they activate PPAR-alpha, markedly reducing triglyceride synthesis and increasing HDL.
Question 6: A patient with ST-elevation myocardial infarction (STEMI) undergoing primary PCI should receive which antiplatelet regimen in addition to aspirin?
- Clopidogrel 75 mg daily
- Ticagrelor 90 mg twice daily or prasugrel 10 mg daily (Correct answer)
- Warfarin with target INR 2-3
- Dipyridamole extended-release
Correct answer: Ticagrelor 90 mg twice daily or prasugrel 10 mg daily
Ticagrelor or prasugrel are preferred over clopidogrel in STEMI patients undergoing PCI due to faster onset, greater platelet inhibition, and improved outcomes.
BCPS BCPS Cardiovascular & Specialty Pharmacotherapy 1
Which antihypertensive drug class is the preferred first-line agent for hypertension in patients with chronic kidney disease (CKD) and proteinuria?