PSA Cardiovascular Prescribing 2

Question 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?

Accepted Answer

Urea, electrolytes, and creatinine

Answer

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

Question 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?

Accepted Answer

Continue bisoprolol unless haemodynamically unstable

Answer

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

Question 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?

Accepted Answer

Hypokalaemia sensitises the myocardium to digoxin toxicity

Answer

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

Question 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?

Accepted Answer

Severe hyperkalaemia risk due to reduced renal potassium excretion

Answer

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

Question 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?

Accepted Answer

Amiodarone inhibits CYP2C9, increasing warfarin levels and bleeding risk

Answer

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

(PSA) Prescribing Safety Assessment Practice Test

(PSA) Prescribing Safety Assessment Practice Test

PSA Cardiovascular Prescribing 2