MTM Chronic Disease Management 4

Question 1

A patient with type 2 diabetes and an eGFR of 38 mL/min/1.73m² needs additional glucose lowering. Which agent is contraindicated or not recommended at this eGFR?

Accepted Answer

SGLT-2 inhibitors (most agents lose glycemic efficacy below eGFR 45)

Answer

Most SGLT-2 inhibitors are not recommended for glycemic control when eGFR falls below 45 mL/min/1.73m² due to loss of efficacy, though some may be continued for cardio/renal benefits per updated labeling.

Question 2

Which intervention has the strongest evidence for reducing hospitalizations in patients with heart failure with reduced ejection fraction?

Accepted Answer

Optimizing guideline-directed medical therapy (ACEi/ARB/ARNI + beta-blocker + MRA + SGLT-2i)

Answer

The four-pillar GDMT (RAAS inhibitor, beta-blocker, mineralocorticoid antagonist, and SGLT-2 inhibitor) has robust evidence for reducing hospitalizations and mortality in HFrEF.

Question 3

In a patient with hypertension and bilateral renal artery stenosis, which antihypertensive class is CONTRAINDICATED?

Accepted Answer

ACE inhibitors and ARBs

Answer

ACE inhibitors and ARBs block angiotensin II–mediated efferent arteriole constriction, which can cause acute renal failure in bilateral renal artery stenosis.

Question 4

A patient with persistent asthma uses an inhaled corticosteroid but remains uncontrolled. Per NAEPP Step 3 therapy, the preferred add-on is:

Accepted Answer

A long-acting beta-agonist (LABA) combined with the ICS

Answer

NAEPP Step 3 preferred therapy is a low-dose ICS/LABA combination, which improves bronchodilation and anti-inflammatory control better than ICS dose escalation alone.

Question 5

Which vaccine is recommended annually for all patients with chronic obstructive pulmonary disease regardless of age?

Accepted Answer

Influenza vaccine

Answer

Annual influenza vaccination is recommended for all COPD patients because influenza is a major trigger of COPD exacerbations and is associated with significant morbidity in this population.

(MTM) Medication Therapy Management Board Certification Practice Test

(MTM) Medication Therapy Management Board Certification Practice Test

MTM Chronic Disease Management 4