Quiz on drugs for congestive cardiac failure

A 72-year-old female with HFrEF (EF 35%) is on maximally tolerated doses of carvedilol, lisinopril, and spironolactone. Her heart rate is consistently 78 bpm, and she remains symptomatic with NYHA Class II symptoms. Her blood pressure is 110/70 mmHg. Which of the following medications would be the next most appropriate addition to improve her symptoms and potentially reduce hospitalizations? *

A 55-year-old male with symptomatic HFrEF (EF 25%) is on maximally tolerated doses of carvedilol, lisinopril, and furosemide. His blood pressure is 105/70 mmHg, and his heart rate is 65 bpm. He is still experiencing NYHA Class III symptoms. His serum potassium is 4.8 mEq/L and creatinine is 1.2 mg/dL. Which of the following is the next most appropriate medication to add to his regimen? *

A 75-year-old female with chronic systolic heart failure is admitted for ADHF. She is started on intravenous furosemide. She develops significant muscle cramps and weakness. Her serum potassium is 3.2 mEq/L. Which of the following is the most appropriate management for her hypokalemia? *

A 60-year-old male with ADHF is started on intravenous dobutamine for cardiogenic shock. He develops new-onset atrial fibrillation with a rapid ventricular response (RVR). His blood pressure is 90/60 mmHg. Which of the following is the most appropriate initial management for his atrial fibrillation in this context? *

A 78-year-old female with HFpEF and atrial fibrillation is admitted for ADHF with dyspnea and peripheral edema. She is currently on amiodarone for rate control. Her BP is 150/90 mmHg and HR is 90 bpm. She is started on furosemide and metoprolol. Which of the following potential drug interactions should be closely monitored with the concurrent use of amiodarone and metoprolol? *

A 65-year-old male with HFrEF (EF 30%) is on carvedilol, lisinopril, and furosemide. He develops a cough and angioedema. His serum creatinine has increased by 0.5 mg/dL. Which of the following is the most appropriate next step in management? *

A 70-year-old male with chronic kidney disease (CKD Stage 4, baseline Cr 2.0 mg/dL) and HFrEF (EF 28%) is on lisinopril, carvedilol, and furosemide. He is experiencing persistent symptoms of dyspnea and fatigue. His potassium is 5.2 mEq/L. He is considered for an aldosterone antagonist. Which of the following is the most appropriate aldosterone antagonist for this patient, considering his renal function and hyperkalemia risk? *

A 68-year-old male with HFrEF (EF 25%) is on carvedilol, lisinopril, and spironolactone. He has a history of hyperkalemia. His current potassium is 5.0 mEq/L. He is still symptomatic with NYHA Class III dyspnea. Which of the following is the next most appropriate medication to consider for further symptom improvement and mortality benefit? *

What is the primary mechanism of action of nesiritide in the management of acute decompensated heart failure? *

A 50-year-old male with a history of dilated cardiomyopathy (EF 20%) presents with severe ADHF. He is hypotensive (BP 80/50 mmHg) and tachycardic (HR 120 bpm) with cool extremities and altered mental status. He is diagnosed with cardiogenic shock. Which of the following is the most appropriate initial pharmacologic intervention? *

A 62-year-old female with a history of hypertension and diabetes presents with worsening dyspnea and fatigue over the past month. She has been taking hydrochlorothiazide and metformin. Echocardiogram reveals an ejection fraction of 55%, but diastolic dysfunction is noted. Her blood pressure is 145/85 mmHg and heart rate is 75 bpm. BNP is elevated at 400 pg/mL. She is diagnosed with HFpEF. Which of the following medications is most likely to improve her symptoms and reduce hospitalizations in HFpEF? *

A 75-year-old female with a history of ischemic cardiomyopathy (EF 30%) and prior myocardial infarction is admitted for ADHF. She is currently on lisinopril, carvedilol, and furosemide. Despite these medications, she remains symptomatic with dyspnea on exertion and peripheral edema. Her electrolytes are: Na 135 mEq/L, K 4.2 mEq/L, Cr 1.1 mg/dL. Which of the following medication additions would be most beneficial for this patient to reduce hospitalizations and mortality? *

A 68-year-old male with a history of hypertension and type 2 diabetes presents to the emergency department with acute shortness of breath, orthopnea, and bilateral leg edema. His vital signs are: BP 160/95 mmHg, HR 110 bpm, RR 28, SpO2 88% on room air. Physical exam reveals crackles in bilateral lung bases and jugular venous distension. BNP is elevated at 1500 pg/mL. He is diagnosed with acute decompensated heart failure (ADHF) with preserved ejection fraction (HFpEF). Which of the following is the most appropriate initial intravenous medication to improve his symptoms and reduce preload? *

Which of the following drug classes is considered a cornerstone in the management of symptomatic HFrEF and has been shown to reduce mortality and hospitalizations? *

Which of the following is a common adverse effect of ACE inhibitors that can limit their use in heart failure patients? *

What is the main goal of using beta-blockers in patients with chronic heart failure? *

Which of the following medications is a phosphodiesterase-3 (PDE3) inhibitor used for short-term management of severe, symptomatic heart failure with reduced ejection fraction in hospitalized patients? *

What is the primary mechanism of action of spironolactone in the management of heart failure? *

Which of the following is a contraindication to the use of an angiotensin receptor-neprilysin inhibitor (ARNI) such as sacubitril/valsartan? *