Advanced Pharmacology Flashcards

A patient with heart failure with reduced ejection fraction (HFrEF, EF 30%) is being optimized on guideline-directed medical therapy. Which combination of four drug classes forms the current cornerstone of HFrEF pharmacotherapy per 2022 AHA/ACC guidelines?

Answer: ACE inhibitor/ARB/ARNI, beta-blocker, MRA, and SGLT2 inhibitor

The 2022 AHA/ACC HF guidelines establish four foundational drug classes (the 'fantastic four'): ARNI (or ACEi/ARB), beta-blocker, MRA, and SGLT2 inhibitor.

A post-surgical patient requires anticoagulation for acute DVT but has severe thrombocytopenia (platelets 35,000/uL). Which anticoagulant consideration is most appropriate?

Answer: Anticoagulation decisions must balance thrombosis risk against bleeding risk; IVC filter may be appropriate if anticoagulation is contraindicated due to severe thrombocytopenia

Severe thrombocytopenia creates significant bleeding risk from anticoagulation — clinical decision-making requires individualized risk-benefit analysis, and IVC filter may be appropriate if anticoagulation is contraindicated.

A patient with alcohol use disorder is admitted for medically supervised detoxification. The CNS reviews the Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) protocol. Which pharmacological class is most evidence-based for alcohol withdrawal treatment?

Answer: Benzodiazepines (lorazepam, diazepam, chlordiazepoxide) for GABA-A receptor-mediated seizure prophylaxis

Benzodiazepines are the gold-standard pharmacological treatment for alcohol withdrawal — they cross-tolerate with alcohol at GABA-A receptors, prevent seizures, and reduce delirium risk.

A patient on warfarin presents with supratherapeutic INR of 6.8 and minor bleeding (gum bleeding). Warfarin was initiated 10 days ago for new-onset AF. What is the most appropriate reversal strategy?

Answer: Hold warfarin, administer vitamin K 2.5 mg orally, and monitor INR; resume warfarin at reduced dose when INR therapeutic

For supratherapeutic INR 6.8 with minor bleeding, holding warfarin plus low-dose oral vitamin K (2.5 mg) provides gradual correction without over-reversal that would increase AF-related stroke risk.

A patient with schizophrenia on clozapine develops an absolute neutrophil count (ANC) of 900/uL (Grade 3 neutropenia). What action is required by the FDA REMS program for clozapine?

Answer: Interrupt clozapine therapy immediately; ANC <1000/uL requires treatment interruption per REMS requirements

FDA REMS for clozapine requires immediate interruption when ANC drops below 1000/uL (Grade 3 neutropenia or worse) — clozapine-induced agranulocytosis is potentially fatal.

A CNS is reviewing pharmacotherapy for a patient with type 2 diabetes, CKD stage 3a (eGFR 52), and recent hospitalization for heart failure. Which medication class provides the greatest benefit across all three conditions simultaneously?

Answer: SGLT2 inhibitors (dapagliflozin, empagliflozin) — reduce glucose, protect kidneys, and reduce HF hospitalizations

SGLT2 inhibitors have proven benefits in T2DM, CKD progression (CREDENCE, DAPA-CKD trials), and heart failure (DAPA-HF, EMPEROR-Reduced) — making them ideal for this clinical scenario.