Practice Test Geeks(PSA) Prescribing Safety Assessment Practice Test
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Cardiovascular Prescribing Flashcards

7 cards from real PSA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Cardiovascular Prescribing flashcards as text

  1. A 68-year-old man with newly diagnosed HFrEF (EF 30%) is started on ramipril 1.25mg twice daily. Which monitoring is essential 1–2 weeks after initiation?

    Answer: Urea, electrolytes, and creatinine

    ACE inhibitors can cause acute kidney injury and hyperkalaemia; urea, electrolytes, and creatinine must be checked within 1–2 weeks of starting.

  2. A 65-year-old man on bisoprolol 5mg daily for HFrEF develops an acute COPD exacerbation requiring nebulised salbutamol. What is the most appropriate action regarding bisoprolol?

    Answer: Continue bisoprolol unless haemodynamically unstable

    Cardioselective beta-blockers should not be stopped abruptly in heart failure even during COPD exacerbations, as abrupt withdrawal risks acute decompensation.

  3. A patient with systolic heart failure on furosemide 80mg daily has a potassium of 3.0 mmol/L and is also prescribed digoxin. Why is this particularly dangerous?

    Answer: Hypokalaemia sensitises the myocardium to digoxin toxicity

    Hypokalaemia increases myocardial sensitivity to digoxin, raising the risk of life-threatening arrhythmias even at therapeutic digoxin levels.

  4. A 77-year-old man with HFrEF is considered for spironolactone 25mg daily. His eGFR is 26 mL/min. What is the primary prescribing concern?

    Answer: Severe hyperkalaemia risk due to reduced renal potassium excretion

    Spironolactone is generally avoided when eGFR < 30 mL/min because impaired renal potassium excretion combined with aldosterone antagonism markedly increases hyperkalaemia risk.

  5. A 60-year-old woman with heart failure and AF on warfarin (INR 2–3) is started on amiodarone. What interaction should be anticipated?

    Answer: Amiodarone inhibits CYP2C9, increasing warfarin levels and bleeding risk

    Amiodarone potently inhibits CYP2C9, the enzyme responsible for S-warfarin metabolism, causing significantly elevated INR and increased haemorrhage risk.

  6. A patient with HFrEF previously on ramipril is being switched to sacubitril/valsartan. What is the minimum washout period required after stopping ramipril?

    Answer: 36 hours

    A 36-hour washout after stopping an ACE inhibitor is required before starting sacubitril/valsartan to minimise the risk of angioedema from combined bradykinin accumulation.

  7. A 74-year-old man with HFrEF has a BP of 88/60 mmHg at clinic. He is on ramipril 10mg, bisoprolol 10mg, furosemide 80mg, and spironolactone 25mg daily. Which medication should be reduced first?

    Answer: Furosemide

    In symptomatic hypotension in HFrEF, the diuretic is typically reduced first as it contributes to low filling pressures without direct survival benefit.