MTM Diabetes & Cardiovascular Pharmacotherapy 3 — Questions and Answers
Question 1: A patient with T2DM and heart failure with reduced ejection fraction (HFrEF) is on an SGLT2 inhibitor. Which additional medication class has been shown to reduce mortality in HFrEF?
- DPP-4 inhibitors
- Sulfonylureas
- Sacubitril/valsartan (ARNI) (Correct answer)
- Pioglitazone
Correct answer: Sacubitril/valsartan (ARNI)
Sacubitril/valsartan is a guideline-directed therapy for HFrEF that reduces mortality and is appropriate alongside SGLT2 inhibitors.
Question 2: Which DPP-4 inhibitor has been shown to increase the risk of hospitalization for heart failure in the SAVOR-TIMI trial?
- Sitagliptin
- Alogliptin
- Saxagliptin (Correct answer)
- Linagliptin
Correct answer: Saxagliptin
Saxagliptin (SAVOR-TIMI 53) was associated with a statistically significant increase in hospitalization for heart failure.
Question 3: A patient on warfarin for atrial fibrillation starts insulin glargine for newly diagnosed T2DM. What counseling point is most important?
- Insulin has no interaction with warfarin
- Hypoglycemia can alter INR monitoring accuracy (Correct answer)
- Insulin will decrease warfarin metabolism increasing bleeding risk
- Glargine reduces vitamin K absorption
Correct answer: Hypoglycemia can alter INR monitoring accuracy
Significant hypoglycemia can affect INR readings and alter hepatic metabolism, requiring closer anticoagulation monitoring.
Question 4: Which of the following statins carries the highest risk of myopathy due to drug interactions with CYP3A4 inhibitors?
- Rosuvastatin
- Pravastatin
- Simvastatin (Correct answer)
- Fluvastatin
Correct answer: Simvastatin
Simvastatin is extensively metabolized by CYP3A4, making it most susceptible to dose-dependent myopathy when combined with strong CYP3A4 inhibitors.
Question 5: A diabetic patient with prior MI and LDL of 85 mg/dL on high-intensity statin therapy asks if they need additional lipid-lowering therapy. According to ACC/AHA guidelines, what is the LDL target for very high-risk ASCVD patients?
- Less than 100 mg/dL
- Less than 70 mg/dL (Correct answer)
- Less than 55 mg/dL
- Less than 40 mg/dL
Correct answer: Less than 70 mg/dL
ACC/AHA guidelines recommend an LDL goal of less than 70 mg/dL for very high-risk ASCVD patients, with ezetimibe or PCSK9 inhibitors added if needed.
Question 6: Which beta-blocker is considered cardioselective and preferred in patients with T2DM and hypertension?
- Propranolol
- Carvedilol
- Metoprolol succinate (Correct answer)
- Labetalol
Correct answer: Metoprolol succinate
Metoprolol succinate is a cardioselective beta-1 blocker that has less tendency to mask hypoglycemic symptoms and blunt counter-regulatory responses than non-selective agents.
Question 7: A patient with T2DM and peripheral artery disease (PAD) is initiated on antiplatelet therapy. Which agent is preferred over aspirin alone based on COMPASS trial data?
- Clopidogrel monotherapy
- Aspirin plus low-dose rivaroxaban (Correct answer)
- Ticagrelor monotherapy
- Warfarin monotherapy
Correct answer: Aspirin plus low-dose rivaroxaban
The COMPASS trial showed that aspirin plus low-dose rivaroxaban (2.5 mg BID) significantly reduced major adverse limb and CV events in patients with PAD.
MTM Diabetes & Cardiovascular Pharmacotherapy 3
A patient with T2DM and heart failure with reduced ejection fraction (HFrEF) is on an SGLT2 inhibitor.
Which additional medication class has been shown to reduce mortality in HFrEF?