Quiz on drugs for congestive cardiac failure

Which of the following classes of drugs is considered a cornerstone in the management of HFrEF and has demonstrated significant mortality benefit? *

A 45-year-old male with a history of idiopathic dilated cardiomyopathy (EF 20%) is admitted for ADHF. He is currently taking oral furosemide 80 mg twice daily, lisinopril 20 mg daily, and carvedilol 25 mg twice daily. On admission, he is hypotensive with a BP of 85/50 mmHg and has cool extremities. His serum potassium is 4.5 mEq/L and creatinine is 1.3 mg/dL. Which of the following is the most appropriate initial approach to manage his hypotension and ADHF? *

A 70-year-old male with HFrEF (EF 35%) is on a stable regimen of sacubitril/valsartan, carvedilol, and spironolactone. He develops a cough and is found to have an elevated serum creatinine (2.0 mg/dL) and potassium (5.5 mEq/L). His blood pressure is 130/80 mmHg. Which of the following is the most appropriate next step? *

A 72-year-old male with a history of hypertension and type 2 diabetes presents to the emergency department with acute shortness of breath, bilateral lower extremity edema up to his knees, and orthopnea. His vital signs are: BP 160/95 mmHg, HR 110 bpm, RR 28/min, O2 saturation 88% on room air. Physical exam reveals crackles in bilateral lung bases and jugular venous distention. His BNP is elevated at 1200 pg/mL. He is diagnosed with acute decompensated heart failure (ADHF) with reduced ejection fraction (HFrEF). Which of the following is the most appropriate initial pharmacological management? *

A 75-year-old male with chronic kidney disease (CKD) stage 4 and HFrEF (EF 28%) is being managed with an ACE inhibitor, a beta-blocker, and furosemide. His serum potassium is consistently around 5.0 mEq/L, and his creatinine is 2.5 mg/dL. Which of the following medications, commonly used in HFrEF, should be used with extreme caution or avoided in this patient due to his renal impairment and hyperkalemia risk? *

A 70-year-old female with a history of HFpEF is admitted for worsening peripheral edema and dyspnea. She has a history of hypertension and atrial fibrillation. Her ejection fraction is 50%. She is currently taking losartan and hydrochlorothiazide. Her serum creatinine is 1.1 mg/dL and potassium is 4.2 mEq/L. She is still symptomatic with NYHA class III symptoms. Which of the following medications should be considered to improve her symptoms and potentially reduce hospitalizations? *

What is the primary mechanism of action of sacubitril/valsartan in the treatment of heart failure? *

A 58-year-old male with HFrEF (EF 30%) is experiencing persistent symptoms of dyspnea and fatigue despite maximally tolerated doses of an ACE inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist. His heart rate is 75 bpm and he is in sinus rhythm. Which of the following medications should be considered next to further improve symptoms and reduce hospitalizations? *

Which of the following is a common and potentially serious adverse effect of ACE inhibitors used in heart failure? *

A 65-year-old female with known HFrEF (EF 30%) is on maximally tolerated doses of lisinopril, carvedilol, and furosemide. She continues to experience exertional dyspnea and has gained 5 lbs in the last week. Her serum sodium is 132 mEq/L and serum potassium is 4.0 mEq/L. Her creatinine is 1.2 mg/dL. Which of the following medications should be considered for addition to her regimen to improve her symptoms and prognosis? *

A 60-year-old female with a history of hypertension and atrial fibrillation (rate controlled) presents with symptoms of fatigue and mild dyspnea on exertion. Her ejection fraction is 45%. She is currently taking hydrochlorothiazide for hypertension. Which of the following medications, when added to her regimen, has been shown to reduce cardiovascular mortality in patients with symptomatic HFrEF? *

A 55-year-old male with a history of myocardial infarction and now diagnosed with HFrEF (EF 25%) is being initiated on guideline-directed medical therapy. He is already on a beta-blocker and an ACE inhibitor. Which of the following medications is indicated to reduce mortality in this patient population? *

A 68-year-old female with a history of hypertension and recent diagnosis of heart failure with preserved ejection fraction (HFpEF) presents with worsening dyspnea on exertion and bilateral ankle edema. Her ejection fraction is 55%. Her blood pressure is 145/88 mmHg. She is already on an ACE inhibitor for hypertension. Which of the following medications is the most appropriate to consider for management of her HFpEF symptoms and reducing hospitalizations? *