NR 565 Advanced Pharmacology Week 4 Questions
Proctored Via Examplify Chamberlain University
With Correct - answers | 100% Pass Guaranteed |
Graded A+ |
1. A 68-year-old patient with heart failure with reduced ejection
fraction (HFrEF, EF 28%) is admitted with acute decompensation.
Home medications include lisinopril 20mg daily, carvedilol 6.25mg
BID, and furosemide 40mg daily. Despite IV diuresis, they remain
symptomatic. The provider wants to initiate sacubitril/valsartan.
What is the MOST appropriate transition strategy from lisinopril?
a) Stop lisinopril and start sacubitril/valsartan 24/26 mg BID the next
day.
b) Stop lisinopril, wait 36 hours, then start sacubitril/valsartan 49/51
mg BID.
c) Stop lisinopril, wait 24 hours, then start sacubitril/valsartan 24/26 mg
BID.
d) Overlap lisinopril and sacubitril/valsartan for one week, then stop
lisinopril.
- answer: B) Stop lisinopril, wait 36 hours, then start
sacubitril/valsartan 49/51 mg BID.
, • Rationale: To minimize the risk of angioedema, there must be
a 36-hour washout period when switching from an ACE inhibitor
(like lisinopril) to sacubitril/valsartan (an ARNI). The starting dose
for patients not currently taking an ACEI/ARB at target doses
is 24/26 mg BID, but for those on a moderate dose of ACEI
(lisinopril 20mg is moderate), an intermediate dose of 49/51 mg
BID is often appropriate. The key is the 36-hour wait, making B
correct over C (24 hours). Overlap (D) is contraindicated.
2. A patient with HFrEF (EF 30%) and chronic kidney disease (eGFR 38
mL/min) is on sacubitril/valsartan 97/103 mg BID. The provider wants
to add a SGLT2 inhibitor. Which agent has a specific FDA indication for
reducing cardiovascular death and hospitalization in HFrEF, regardless
of diabetes status, and requires dose adjustment for this level of renal
function?
a) Empagliflozin 10 mg daily
b) Canagliflozin 100 mg daily
c) Dapagliflozin 10 mg daily
d) Ertugliflozin 5 mg daily
- answer: C) Dapagliflozin 10 mg daily
• Rationale: Dapagliflozin is FDA-approved for HFrEF in patients
with and without Type 2 diabetes. Its dosing is 10 mg once
daily and is not recommended for initiation when eGFR is <25
mL/min (but can be continued if eGFR falls later). Empagliflozin
(A) is approved for HFrEF but at a dose of 10 mg daily. However,
the question asks which one requires dose adjustment—neither
dapagliflozin nor empagliflozin require adjustment down to eGFR
of 25. But the specific language "requires dose adjustment for this
level of renal function" might be a trick. For CKD, dapagliflozin is
not initiated if eGFR <25, but no dose adjustment is needed above
, that. Empagliflozin is the same. However, canagliflozin (B) is not
approved for HFrEF. Given the specific FDA indication and
common use, C is the best - answer.
3. A patient with HFrEF, NYHA Class III, is on optimal GDMT but
continues to have debilitating fatigue. The provider considers adding
ivabradine. Which specific criterion MUST be met for ivabradine to be
indicated?
a) EF ≤35%, sinus rhythm, and resting heart rate ≥70 bpm on maximally
tolerated beta-blocker.
b) EF ≤40%, any rhythm, and symptomatic despite ACEI/ARNI and beta-
blocker.
c) EF ≤35%, atrial fibrillation, and resting heart rate ≥80 bpm.
d) EF ≤30%, sinus rhythm, and intolerance to beta-blockers.
- answer: A) EF ≤35%, sinus rhythm, and resting heart rate ≥70 bpm on
maximally tolerated beta-blocker.
• Rationale: Ivabradine is a selective sinus node inhibitor indicated
to reduce HF hospitalization in stable, symptomatic HFrEF
(EF≤35%) in sinus rhythm with a resting heart rate ≥70
bpm despite receiving maximally tolerated beta-blocker
therapy (or who are intolerant to beta-blockers). It does not work
in atrial fibrillation. The heart rate criterion is critical.
4. A patient with acute decompensated HF and severe pulmonary
edema is receiving IV nitroglycerin and high-dose IV furosemide. The
provider considers adding nesiritide. Which of the following is a TRUE
statement about nesiritide's role based on current evidence?
a) It provides sustained symptomatic relief and reduces mortality when
added to standard care.
b) It is a recombinant BNP that causes arterial and venous dilation, but
its use is limited due to lack of mortality benefit and risk of
, hypotension.
c) It is a potent inotrope and should be used instead of dobutamine in
patients with borderline blood pressure.
d) It promotes diuresis and natriuresis without affecting
hemodynamics.
- answer: B) It is a recombinant BNP that causes arterial and venous
dilation, but its use is limited due to lack of mortality benefit and risk
of hypotension.
• Rationale: Nesiritide is recombinant human B-type natriuretic
peptide. It produces venous and arterial dilation, reducing
preload and afterload. However, major trials (ASCEND-HF)
showed it did not improve mortality or rehospitalization and was
associated with increased hypotension. Its use is now very
limited. It is not an inotrope (C) and does not provide sustained
relief or mortality benefit (A).
5. For a patient with HFrEF and persistent hyperkalemia (K+ 5.3-5.8
mEq/L) limiting the uptitration of an ACEI/ARNI and MRA, which
potassium-binding agent is specifically approved for this indication
and works in the GI tract by trapping potassium in the colon?
a) Sodium polystyrene sulfonate (Kayexalate)
b) Patiromer (Veltassa)
c) Sodium zirconium cyclosilicate (Lokelma)
d) Calcium polystyrene sulfonate
- answer: B) Patiromer (Veltassa)
• Rationale: Both patiromer and sodium zirconium cyclosilicate
(SZC) are approved for hyperkalemia. However, patiromer has
a specific indication for allowing patients to continue RAAS
inhibitors (like MRAs) in the face of hyperkalemia. It is a non-
Proctored Via Examplify Chamberlain University
With Correct - answers | 100% Pass Guaranteed |
Graded A+ |
1. A 68-year-old patient with heart failure with reduced ejection
fraction (HFrEF, EF 28%) is admitted with acute decompensation.
Home medications include lisinopril 20mg daily, carvedilol 6.25mg
BID, and furosemide 40mg daily. Despite IV diuresis, they remain
symptomatic. The provider wants to initiate sacubitril/valsartan.
What is the MOST appropriate transition strategy from lisinopril?
a) Stop lisinopril and start sacubitril/valsartan 24/26 mg BID the next
day.
b) Stop lisinopril, wait 36 hours, then start sacubitril/valsartan 49/51
mg BID.
c) Stop lisinopril, wait 24 hours, then start sacubitril/valsartan 24/26 mg
BID.
d) Overlap lisinopril and sacubitril/valsartan for one week, then stop
lisinopril.
- answer: B) Stop lisinopril, wait 36 hours, then start
sacubitril/valsartan 49/51 mg BID.
, • Rationale: To minimize the risk of angioedema, there must be
a 36-hour washout period when switching from an ACE inhibitor
(like lisinopril) to sacubitril/valsartan (an ARNI). The starting dose
for patients not currently taking an ACEI/ARB at target doses
is 24/26 mg BID, but for those on a moderate dose of ACEI
(lisinopril 20mg is moderate), an intermediate dose of 49/51 mg
BID is often appropriate. The key is the 36-hour wait, making B
correct over C (24 hours). Overlap (D) is contraindicated.
2. A patient with HFrEF (EF 30%) and chronic kidney disease (eGFR 38
mL/min) is on sacubitril/valsartan 97/103 mg BID. The provider wants
to add a SGLT2 inhibitor. Which agent has a specific FDA indication for
reducing cardiovascular death and hospitalization in HFrEF, regardless
of diabetes status, and requires dose adjustment for this level of renal
function?
a) Empagliflozin 10 mg daily
b) Canagliflozin 100 mg daily
c) Dapagliflozin 10 mg daily
d) Ertugliflozin 5 mg daily
- answer: C) Dapagliflozin 10 mg daily
• Rationale: Dapagliflozin is FDA-approved for HFrEF in patients
with and without Type 2 diabetes. Its dosing is 10 mg once
daily and is not recommended for initiation when eGFR is <25
mL/min (but can be continued if eGFR falls later). Empagliflozin
(A) is approved for HFrEF but at a dose of 10 mg daily. However,
the question asks which one requires dose adjustment—neither
dapagliflozin nor empagliflozin require adjustment down to eGFR
of 25. But the specific language "requires dose adjustment for this
level of renal function" might be a trick. For CKD, dapagliflozin is
not initiated if eGFR <25, but no dose adjustment is needed above
, that. Empagliflozin is the same. However, canagliflozin (B) is not
approved for HFrEF. Given the specific FDA indication and
common use, C is the best - answer.
3. A patient with HFrEF, NYHA Class III, is on optimal GDMT but
continues to have debilitating fatigue. The provider considers adding
ivabradine. Which specific criterion MUST be met for ivabradine to be
indicated?
a) EF ≤35%, sinus rhythm, and resting heart rate ≥70 bpm on maximally
tolerated beta-blocker.
b) EF ≤40%, any rhythm, and symptomatic despite ACEI/ARNI and beta-
blocker.
c) EF ≤35%, atrial fibrillation, and resting heart rate ≥80 bpm.
d) EF ≤30%, sinus rhythm, and intolerance to beta-blockers.
- answer: A) EF ≤35%, sinus rhythm, and resting heart rate ≥70 bpm on
maximally tolerated beta-blocker.
• Rationale: Ivabradine is a selective sinus node inhibitor indicated
to reduce HF hospitalization in stable, symptomatic HFrEF
(EF≤35%) in sinus rhythm with a resting heart rate ≥70
bpm despite receiving maximally tolerated beta-blocker
therapy (or who are intolerant to beta-blockers). It does not work
in atrial fibrillation. The heart rate criterion is critical.
4. A patient with acute decompensated HF and severe pulmonary
edema is receiving IV nitroglycerin and high-dose IV furosemide. The
provider considers adding nesiritide. Which of the following is a TRUE
statement about nesiritide's role based on current evidence?
a) It provides sustained symptomatic relief and reduces mortality when
added to standard care.
b) It is a recombinant BNP that causes arterial and venous dilation, but
its use is limited due to lack of mortality benefit and risk of
, hypotension.
c) It is a potent inotrope and should be used instead of dobutamine in
patients with borderline blood pressure.
d) It promotes diuresis and natriuresis without affecting
hemodynamics.
- answer: B) It is a recombinant BNP that causes arterial and venous
dilation, but its use is limited due to lack of mortality benefit and risk
of hypotension.
• Rationale: Nesiritide is recombinant human B-type natriuretic
peptide. It produces venous and arterial dilation, reducing
preload and afterload. However, major trials (ASCEND-HF)
showed it did not improve mortality or rehospitalization and was
associated with increased hypotension. Its use is now very
limited. It is not an inotrope (C) and does not provide sustained
relief or mortality benefit (A).
5. For a patient with HFrEF and persistent hyperkalemia (K+ 5.3-5.8
mEq/L) limiting the uptitration of an ACEI/ARNI and MRA, which
potassium-binding agent is specifically approved for this indication
and works in the GI tract by trapping potassium in the colon?
a) Sodium polystyrene sulfonate (Kayexalate)
b) Patiromer (Veltassa)
c) Sodium zirconium cyclosilicate (Lokelma)
d) Calcium polystyrene sulfonate
- answer: B) Patiromer (Veltassa)
• Rationale: Both patiromer and sodium zirconium cyclosilicate
(SZC) are approved for hyperkalemia. However, patiromer has
a specific indication for allowing patients to continue RAAS
inhibitors (like MRAs) in the face of hyperkalemia. It is a non-
