BCACP - Board Certified Ambulatory Care Pharmacist Cardiovascular Disease Management Questions and Answers

Question 1

A 68-year-old male with a history of myocardial infarction 2 years ago presents for a follow-up visit. His current medications include atorvastatin 80 mg daily, lisinopril 20 mg daily, metoprolol succinate 100 mg daily, and aspirin 81 mg daily. His recent lipid panel shows an LDL-C of 85 mg/dL. According to the 2026 ACC/AHA Guideline on the Management of Dyslipidemia, which of the following is the most appropriate next step?

Accepted Answer

Add ezetimibe 10 mg daily.

Answer

According to the 2026 ACC/AHA dyslipidemia guidelines, patients with clinical atherosclerotic cardiovascular disease (ASCVD) are considered at very high risk. The recommended LDL-C goal for this population is less than 55 mg/dL. Since the patient is already on maximally tolerated high-intensity statin therapy and his LDL-C remains above goal, the next step is to add a non-statin agent. Ezetimibe is the recommended first-line add-on therapy.

Question 2

A 52-year-old female is diagnosed with Stage 1 hypertension with a blood pressure reading of 136/88 mmHg. She has no other medical conditions. Her calculated 10-year PREVENT-ASCVD risk score is 4%. Based on the 2025 ACC/AHA hypertension guideline, what is the MOST appropriate initial recommendation?

Accepted Answer

Recommend lifestyle modifications, including dietary changes and physical activity, and re-evaluate in 3-6 months.

Answer

The 2025 ACC/AHA hypertension guideline recommends initiating antihypertensive medication for Stage 1 hypertension if the patient has clinical ASCVD or a 10-year PREVENT risk of ≥7.5%. For patients with Stage 1 hypertension and a lower risk (<7.5%), a 3- to 6-month trial of lifestyle modification is recommended before initiating pharmacotherapy.

Question 3

Which of the following medication classes is now considered one of the four essential pillars of guideline-directed medical therapy (GDMT) for all patients with heart failure with reduced ejection fraction (HFrEF), regardless of diabetes status?

Accepted Answer

Sodium-glucose cotransporter-2 (SGLT2) inhibitors

Answer

The 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure establishes four foundational medication classes for HFrEF: 1) Renin-angiotensin system inhibitors (ARNI, ACEi, or ARB), 2) Beta-blockers, 3) Mineralocorticoid receptor antagonists (MRAs), and 4) SGLT2 inhibitors. SGLT2 inhibitors are recommended for all patients with symptomatic chronic HFrEF to reduce hospitalizations and cardiovascular mortality, irrespective of the presence of type 2 diabetes.

Question 4

A 76-year-old female with hypertension and type 2 diabetes is newly diagnosed with paroxysmal atrial fibrillation. She has no history of stroke. What is her CHA2DS2-VASc score, and what is the most appropriate anticoagulant recommendation according to the 2023 ACC/AHA/ACCP/HRS guideline?

Accepted Answer

Score of 4; recommend apixaban or another direct oral anticoagulant (DOAC).

Answer

The CHA2DS2-VASc score is calculated as follows: C (Congestive heart failure) = 0, H (Hypertension) = 1, A2 (Age ≥75) = 2, D (Diabetes) = 1, S2 (Stroke/TIA/TE) = 0, V (Vascular disease) = 0, A (Age 65-74) = 0, Sc (Sex category - female) = 1. The total score is 1+2+1 = 4. A score of ≥2 in males or ≥3 in females indicates a recommendation for oral anticoagulation. The 2023 guidelines strongly recommend a direct oral anticoagulant (DOAC) over warfarin for most patients.

Question 5

A 65-year-old man with hyperlipidemia but no history of ASCVD, diabetes, or increased bleeding risk asks about starting aspirin for primary prevention of a heart attack. His 10-year ASCVD risk is calculated to be 12%. According to the 2022 US Preventive Services Task Force (USPSTF) recommendations, what should the pharmacist advise?

Accepted Answer

Aspirin should not be initiated for primary prevention in this age group.

Answer

The 2022 USPSTF guidelines recommend against routinely initiating low-dose aspirin for the primary prevention of ASCVD in adults 60 years or older. The potential for harm from bleeding outweighs the potential benefits in this age group. Therefore, aspirin should not be initiated.

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP - Board Certified Ambulatory Care Pharmacist Cardiovascular Disease Management Questions and Answers