PSA Cardiovascular Prescribing 1 — Questions and Answers
Question 1: What is the first-line treatment for hypertension?
- ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics depending on patient characteristics (Correct answer)
- Only beta-blockers
- No medication until blood pressure exceeds 200/120
- Surgery
Correct answer: ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics depending on patient characteristics
First-line antihypertensives are chosen based on age, ethnicity, and comorbidities: ACE inhibitors/ARBs for younger patients, CCBs for older patients and Black patients.
Question 2: Why is aspirin prescribed after a myocardial infarction?
- To inhibit platelet aggregation and reduce the risk of further cardiovascular events (Correct answer)
- To reduce pain only
- To lower blood pressure
- To reduce cholesterol
Correct answer: To inhibit platelet aggregation and reduce the risk of further cardiovascular events
Low-dose aspirin irreversibly inhibits platelet cyclooxygenase, reducing platelet aggregation and the risk of further thrombotic events after MI.
Question 3: What is the role of statins in cardiovascular disease?
- To lower LDL cholesterol, reduce cardiovascular risk, and stabilize atherosclerotic plaques (Correct answer)
- Only to reduce cholesterol for cosmetic reasons
- To treat high blood pressure
- To increase HDL cholesterol only
Correct answer: To lower LDL cholesterol, reduce cardiovascular risk, and stabilize atherosclerotic plaques
Statins reduce LDL cholesterol through HMG-CoA reductase inhibition and have additional benefits including plaque stabilization and anti-inflammatory effects.
Question 4: What monitoring is required for patients on ACE inhibitors?
- Renal function (creatinine/eGFR) and potassium levels, especially after initiation and dose changes (Correct answer)
- No monitoring is needed
- Only blood pressure monitoring
- Only cholesterol levels
Correct answer: Renal function (creatinine/eGFR) and potassium levels, especially after initiation and dose changes
ACE inhibitors can cause hyperkalemia and acute kidney injury. Renal function and potassium should be checked before starting, after 1-2 weeks, and after dose changes.
Question 5: What is the difference between rate control and rhythm control in atrial fibrillation?
- Rate control slows the heart rate; rhythm control attempts to restore normal sinus rhythm (Correct answer)
- They are the same treatment
- Rate control is always preferred
- Rhythm control is the only option
Correct answer: Rate control slows the heart rate; rhythm control attempts to restore normal sinus rhythm
Rate control uses beta-blockers or CCBs to manage ventricular rate, while rhythm control uses antiarrhythmics or cardioversion to restore normal rhythm. Choice depends on symptoms and patient factors.
Question 6: Why is anticoagulation important in atrial fibrillation?
- AF causes blood stasis in the atria, increasing stroke risk; anticoagulants reduce this risk (Correct answer)
- Anticoagulants treat the AF itself
- Only patients with symptoms need anticoagulation
- Anticoagulation is never needed in AF
Correct answer: AF causes blood stasis in the atria, increasing stroke risk; anticoagulants reduce this risk
The irregular contraction in AF allows blood to pool in the atria, forming clots that can travel to the brain causing stroke. Anticoagulants prevent clot formation.
PSA Cardiovascular Prescribing 1
What is the first-line treatment for hypertension?