APEA PHARMACOLOGY ACTUAL
EXAM 1 With Questions And
Answers With Rationales/Graded
A+/2026 Update/100% Correct
Section 1: Cardiovascular Pharmacology (Qs 1–15)
1. A 58-year-old with HFrEF (EF 30%) on sacubitril/valsartan develops
angioedema. Next step?
A) Continue drug, add antihistamine
B) Switch to lisinopril
C) Discontinue drug, avoid ARBs for 36 hours, consider hydralazine/nitrates
D) Reduce dose by 50%
Rationale: Sacubitril/valsartan carries a risk of angioedema similar to ACEIs. It
must be stopped; ARBs should be avoided for 36 hours due to cross-reactivity.
Lisinopril is contraindicated.
2. Which drug is preferred for rate control in acute atrial fibrillation with pre-
excitation (WPW)?
A) Metoprolol IV
B) Diltiazem IV
C) Digoxin IV
D) Procainamide IV
Rationale: AV nodal blockers (beta-blockers, CCBs, digoxin) can accelerate
conduction via accessory pathway. Procainamide slows conduction in accessory
pathway.
3. A patient on warfarin has INR 4.5 without bleeding. Management?
A) Vitamin K 10 mg PO
B) Hold warfarin, no vitamin K
C) Fresh frozen plasma
D) Increase warfarin dose
,Rationale: INR 4.5 (therapeutic range 2-3) – hold warfarin, recheck INR. Vitamin
K only if >5-10 or bleeding.
4. First-line therapy for chronic stable angina with prior MI?
A) Aspirin alone
B) Metoprolol succinate
C) Amlodipine
D) Ranolazine
Rationale: Beta-blockers reduce mortality post-MI, decrease myocardial O2
demand, first-line for angina.
5. Which DOAC requires dose reduction for CrCl 25 mL/min?
A) Apixaban
B) Rivaroxaban for DVT
C) Dabigatran
D) Edoxaban for DVT
Rationale: Dabigatran is contraindicated if CrCl <30 mL/min (2026: avoid unless
on dialysis). Apixaban can be used with caution.
6. Statin-induced myalgia with CK normal – best approach?
A) Stop statin permanently
B) Switch to rosuvastatin 5 mg twice weekly
C) Add ezetimibe alone
D) Double current dose
Rationale: Non-CK myalgia: alternate day or twice weekly rosuvastatin or
pitavastatin (less myotoxicity). Ezetimibe is adjunct.
7. Spironolactone in HFrEF – most critical lab to monitor at 1 week?
A) BUN
B) Potassium and creatinine
C) Magnesium
D) Hemoglobin
Rationale: Spironolactone causes hyperkalemia and reversible renal impairment –
check K+ and Cr at 1 week and 4 weeks.
8. Which drug is most likely to cause gingival hyperplasia?
A) Losartan
B) Nifedipine
, C) Hydralazine
D) Clonidine
Rationale: Dihydropyridine CCBs (especially nifedipine, amlodipine less so)
cause gingival hyperplasia.
9. Patient on clopidogrel with CYP2C19 loss-of-function (LOF) allele –
recommendation?
A) Increase clopidogrel to 150 mg
B) Add aspirin 325 mg
C) Switch to ticagrelor
D) No change
Rationale: 2026 guideline: genotyping recommended post-PCI; LOF carriers use
ticagrelor or prasugrel (if no bleeding risk).
10. Ivabradine indication?
A) HFrEF, EF <35%, in sinus rhythm, HR ≥70 on max beta-blocker
B) Atrial fibrillation with RVR
C) Hypertension with bradycardia
D) Prinzmetal angina
Rationale: Ivabradine reduces HR via If channel – only for HFrEF, sinus rhythm,
HR ≥70 despite BB.
11. Drug-induced lupus – most common causative agent?
A) Isoniazid
B) Hydralazine
C) Procainamide
D) Minocycline
Rationale: Hydralazine (high risk – up to 20% with slow acetylators), then
procainamide, isoniazid.
12. Which SGLT2 inhibitor has the strongest mortality benefit in HFpEF?
A) Canagliflozin
B) Dapagliflozin
C) Empagliflozin
D) Ertugliflozin
EXAM 1 With Questions And
Answers With Rationales/Graded
A+/2026 Update/100% Correct
Section 1: Cardiovascular Pharmacology (Qs 1–15)
1. A 58-year-old with HFrEF (EF 30%) on sacubitril/valsartan develops
angioedema. Next step?
A) Continue drug, add antihistamine
B) Switch to lisinopril
C) Discontinue drug, avoid ARBs for 36 hours, consider hydralazine/nitrates
D) Reduce dose by 50%
Rationale: Sacubitril/valsartan carries a risk of angioedema similar to ACEIs. It
must be stopped; ARBs should be avoided for 36 hours due to cross-reactivity.
Lisinopril is contraindicated.
2. Which drug is preferred for rate control in acute atrial fibrillation with pre-
excitation (WPW)?
A) Metoprolol IV
B) Diltiazem IV
C) Digoxin IV
D) Procainamide IV
Rationale: AV nodal blockers (beta-blockers, CCBs, digoxin) can accelerate
conduction via accessory pathway. Procainamide slows conduction in accessory
pathway.
3. A patient on warfarin has INR 4.5 without bleeding. Management?
A) Vitamin K 10 mg PO
B) Hold warfarin, no vitamin K
C) Fresh frozen plasma
D) Increase warfarin dose
,Rationale: INR 4.5 (therapeutic range 2-3) – hold warfarin, recheck INR. Vitamin
K only if >5-10 or bleeding.
4. First-line therapy for chronic stable angina with prior MI?
A) Aspirin alone
B) Metoprolol succinate
C) Amlodipine
D) Ranolazine
Rationale: Beta-blockers reduce mortality post-MI, decrease myocardial O2
demand, first-line for angina.
5. Which DOAC requires dose reduction for CrCl 25 mL/min?
A) Apixaban
B) Rivaroxaban for DVT
C) Dabigatran
D) Edoxaban for DVT
Rationale: Dabigatran is contraindicated if CrCl <30 mL/min (2026: avoid unless
on dialysis). Apixaban can be used with caution.
6. Statin-induced myalgia with CK normal – best approach?
A) Stop statin permanently
B) Switch to rosuvastatin 5 mg twice weekly
C) Add ezetimibe alone
D) Double current dose
Rationale: Non-CK myalgia: alternate day or twice weekly rosuvastatin or
pitavastatin (less myotoxicity). Ezetimibe is adjunct.
7. Spironolactone in HFrEF – most critical lab to monitor at 1 week?
A) BUN
B) Potassium and creatinine
C) Magnesium
D) Hemoglobin
Rationale: Spironolactone causes hyperkalemia and reversible renal impairment –
check K+ and Cr at 1 week and 4 weeks.
8. Which drug is most likely to cause gingival hyperplasia?
A) Losartan
B) Nifedipine
, C) Hydralazine
D) Clonidine
Rationale: Dihydropyridine CCBs (especially nifedipine, amlodipine less so)
cause gingival hyperplasia.
9. Patient on clopidogrel with CYP2C19 loss-of-function (LOF) allele –
recommendation?
A) Increase clopidogrel to 150 mg
B) Add aspirin 325 mg
C) Switch to ticagrelor
D) No change
Rationale: 2026 guideline: genotyping recommended post-PCI; LOF carriers use
ticagrelor or prasugrel (if no bleeding risk).
10. Ivabradine indication?
A) HFrEF, EF <35%, in sinus rhythm, HR ≥70 on max beta-blocker
B) Atrial fibrillation with RVR
C) Hypertension with bradycardia
D) Prinzmetal angina
Rationale: Ivabradine reduces HR via If channel – only for HFrEF, sinus rhythm,
HR ≥70 despite BB.
11. Drug-induced lupus – most common causative agent?
A) Isoniazid
B) Hydralazine
C) Procainamide
D) Minocycline
Rationale: Hydralazine (high risk – up to 20% with slow acetylators), then
procainamide, isoniazid.
12. Which SGLT2 inhibitor has the strongest mortality benefit in HFpEF?
A) Canagliflozin
B) Dapagliflozin
C) Empagliflozin
D) Ertugliflozin
