Free NAPLEX QBANK Therapeutic Treatment Planning Questions and Answers 1 — Questions and Answers
Question 1: A 68-year-old male with a new diagnosis of heart failure with reduced ejection fraction (HFrEF) is being evaluated for initiation of guideline-directed medical therapy (GDMT). His vital signs are stable, and he is euvolemic. According to the 2024 ACC Expert Consensus Decision Pathway, which of the following represents the core foundational therapies that should be initiated?
- An ACE inhibitor, a beta-blocker, a loop diuretic, and an aldosterone antagonist.
- An angiotensin receptor blocker (ARB), a beta-blocker, a thiazide diuretic, and digoxin.
- An angiotensin receptor-neprilysin inhibitor (ARNI), an evidence-based beta-blocker, a mineralocorticoid receptor antagonist (MRA), and a sodium-glucose cotransporter-2 (SGLT2) inhibitor. (Correct answer)
- A hydralazine/isosorbide dinitrate combination, a beta-blocker, a loop diuretic, and an SGLT2 inhibitor.
Correct answer: An angiotensin receptor-neprilysin inhibitor (ARNI), an evidence-based beta-blocker, a mineralocorticoid receptor antagonist (MRA), and a sodium-glucose cotransporter-2 (SGLT2) inhibitor.
The 2024 ACC Expert Consensus Decision Pathway for HFrEF recommends initiating all four pillars of guideline-directed medical therapy (GDMT) as tolerated. These core therapies are an ARNI, an evidence-based beta-blocker, an MRA, and an SGLT2 inhibitor. This combination has been shown to significantly reduce morbidity and mortality in patients with HFrEF. While ACE inhibitors/ARBs and diuretics are used in heart failure management, the four-drug regimen listed is considered the foundational therapy.
Question 2: A 55-year-old female is newly diagnosed with type 2 diabetes. Her initial A1C is 7.2%, and she has no history of atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease. Which of the following is the most appropriate first-line pharmacologic agent to initiate in addition to lifestyle modifications?
- Glipizide
- Empagliflozin
- Metformin (Correct answer)
- Insulin glargine
Correct answer: Metformin
For most patients with newly diagnosed type 2 diabetes, metformin is the recommended first-line agent, along with comprehensive lifestyle changes. Metformin is effective, has a low risk of hypoglycemia, can promote modest weight loss, and is affordable. Sulfonylureas like glipizide carry a higher risk of hypoglycemia. SGLT2 inhibitors like empagliflozin or basal insulin are typically considered after metformin or as initial therapy in patients with very high A1C or specific comorbidities, which this patient does not have.
Question 3: A 45-year-old patient is initiated on lithium for the management of bipolar disorder. Which of the following sets of baseline laboratory tests is essential to obtain before starting therapy?
- Liver function tests, lipid panel, and hemoglobin A1c.
- Serum creatinine (renal function), thyroid stimulating hormone (TSH), complete blood count (CBC), and a pregnancy test. (Correct answer)
- Uric acid, serum iron, and vitamin B12 levels.
- Chest X-ray, electrocardiogram (ECG), and serum magnesium.
Correct answer: Serum creatinine (renal function), thyroid stimulating hormone (TSH), complete blood count (CBC), and a pregnancy test.
Before initiating lithium, it is crucial to assess baseline renal and thyroid function, as lithium is cleared by the kidneys and can cause hypothyroidism. Therefore, a serum creatinine and TSH are required. A complete blood count is also recommended. For females of childbearing age, a pregnancy test is necessary due to teratogenic risks. While an ECG may be considered in older patients or those with cardiovascular risk, the tests in the correct answer are considered standard for all patients.
Question 4: A 62-year-old male with a history of COPD and diabetes presents to an outpatient clinic with symptoms of community-acquired pneumonia (CAP). He has not been recently hospitalized or received IV antibiotics. According to the 2019 ATS/IDSA guidelines, which of the following is an appropriate empiric antibiotic regimen for this patient?
- Amoxicillin 1 g three times daily
- Azithromycin 500 mg daily
- Amoxicillin/clavulanate 875 mg/125 mg twice daily PLUS doxycycline 100 mg twice daily (Correct answer)
- Ciprofloxacin 500 mg twice daily
Correct answer: Amoxicillin/clavulanate 875 mg/125 mg twice daily PLUS doxycycline 100 mg twice daily
For outpatients with CAP who have comorbidities such as chronic lung disease (COPD) or diabetes, guidelines recommend combination therapy. An appropriate regimen is a beta-lactam (like amoxicillin/clavulanate) plus a macrolide or doxycycline. Monotherapy with amoxicillin is reserved for healthy patients without comorbidities. Macrolide monotherapy is not recommended in many areas due to high rates of pneumococcal resistance. Ciprofloxacin is not a respiratory fluoroquinolone and lacks reliable activity against Streptococcus pneumoniae.
Question 5: A 34-year-old patient is diagnosed with generalized anxiety disorder (GAD) and is seeking pharmacotherapy. The patient has no other medical conditions and takes no other medications. Which of the following medication classes is considered first-line treatment for this condition?
- Benzodiazepines
- Selective Serotonin Reuptake Inhibitors (SSRIs) (Correct answer)
- Tricyclic Antidepressants (TCAs)
- Antipsychotics
Correct answer: Selective Serotonin Reuptake Inhibitors (SSRIs)
According to major treatment guidelines, Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are the first-line medication treatments for generalized anxiety disorder. They are effective and generally well-tolerated for long-term use. While benzodiazepines are effective for short-term symptom relief, they are not recommended as first-line therapy due to risks of dependence and tolerance. TCAs and antipsychotics are typically reserved for treatment-resistant cases.
Question 6: According to the 2017 ACC/AHA High Blood Pressure Clinical Practice Guideline, which of the following is the most appropriate first-line medication choice for a 58-year-old Black male newly diagnosed with Stage 1 hypertension and no other comorbidities?
- Lisinopril
- Atenolol
- Hydrochlorothiazide (Correct answer)
- Losartan
Correct answer: Hydrochlorothiazide
The 2017 ACC/AHA guidelines recommend either a thiazide-type diuretic or a calcium channel blocker as first-line monotherapy for hypertension in Black adults without heart failure or chronic kidney disease. ACE inhibitors (like lisinopril) and ARBs (like losartan) have been shown to be less effective in lowering blood pressure in this population when used as monotherapy. Beta-blockers like atenolol are no longer recommended as initial therapy for hypertension unless the patient has specific comorbidities like ischemic heart disease or heart failure.
Free NAPLEX QBANK Therapeutic Treatment Planning Questions and Answers 1
A 68-year-old male with a new diagnosis of heart failure with reduced ejection fraction (HFrEF) is being evaluated for initiation of guideline-directed medical therapy (GDMT).
His vital signs are stable, and he is euvolemic.
According to the 2024 ACC Expert Consensus Decision Pathway, which of the following represents the core foundational therapies that should be initiated?