APEA Advanced
Pharmacotherapeutics Final Exam –
2026 Edition||Questions And Answers
With Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Section I: Cardiovascular Pharmacotherapy (Questions 1–15)
1. A 68-year-old with HFrEF (EF 30%) on sacubitril/valsartan, carvedilol, and
spironolactone presents with worsening dyspnea. What is the next guideline-
directed therapy (2026 ACC/AHA)?
A. Digoxin 0.125 mg daily
B. Ivabradine 5 mg BID
C. SGLT2 inhibitor (dapagliflozin 10 mg daily)
D. Hydralazine/isosorbide dinitrate
Rationale: 2026 guidelines recommend adding an SGLT2 inhibitor (dapagliflozin
or empagliflozin) to foundational GDMT for HFrEF regardless of diabetes status to
reduce CV death and HF hospitalization.
2. Which DOAC is preferred in a patient with non-valvular atrial fibrillation
and stage 4 CKD (eGFR 22 mL/min)?
A. Rivaroxaban 20 mg daily
B. Apixaban 2.5 mg BID
C. Dabigatran 150 mg BID
D. Apixaban 5 mg BID (or 2.5 mg if ≥2 criteria)
Rationale: Apixaban has the least renal excretion and is approved for CrCl as low
as 15 mL/min. Rivaroxaban and dabigatran are not recommended if CrCl <30
mL/min.
, 3. A patient on atorvastatin 80 mg develops myalgia and CK 6x ULN. LDL
remains 100 mg/dL. Best next step?
A. Switch to rosuvastatin 40 mg
B. Add ezetimibe 10 mg daily
C. Reduce atorvastatin to 40 mg
D. Add bempedoic acid
Rationale: Statin intolerance with CK elevation → add non-statin lipid-lowering
agent. Ezetimibe is first-line add-on before bempedoic acid or PCSK9i per 2026
guidelines.
4. Which drug is contraindicated within 48 hours of tPA in acute ischemic
stroke?
A. Aspirin
B. Clopidogrel
C. Warfarin
D. Apixaban
Rationale: Warfarin (especially with INR >1.7) is excluded from tPA eligibility.
DOACs may be given if last dose >48 hours and normal renal function.
5. First-line antiarrhythmic for vagally mediated atrial fibrillation?
A. Amiodarone
B. Disopyramide
C. Dofetilide
D. Flecainide
Rationale: Disopyramide has anticholinergic effects, useful in vagal AF.
Flecainide is preferred for adrenergic AF.
6. A patient on lisinopril 40 mg develops angioedema. Best alternative in
HFrEF?
A. Losartan
B. Sacubitril/valsartan
C. Aliskiren
D. Hydralazine
Rationale: ARNI (sacubitril/valsartan) is preferred over ARB if previous ACEi
angioedema, but caution — ARNI is contraindicated if angioedema occurred
within 4 weeks of ACEi.
Pharmacotherapeutics Final Exam –
2026 Edition||Questions And Answers
With Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Section I: Cardiovascular Pharmacotherapy (Questions 1–15)
1. A 68-year-old with HFrEF (EF 30%) on sacubitril/valsartan, carvedilol, and
spironolactone presents with worsening dyspnea. What is the next guideline-
directed therapy (2026 ACC/AHA)?
A. Digoxin 0.125 mg daily
B. Ivabradine 5 mg BID
C. SGLT2 inhibitor (dapagliflozin 10 mg daily)
D. Hydralazine/isosorbide dinitrate
Rationale: 2026 guidelines recommend adding an SGLT2 inhibitor (dapagliflozin
or empagliflozin) to foundational GDMT for HFrEF regardless of diabetes status to
reduce CV death and HF hospitalization.
2. Which DOAC is preferred in a patient with non-valvular atrial fibrillation
and stage 4 CKD (eGFR 22 mL/min)?
A. Rivaroxaban 20 mg daily
B. Apixaban 2.5 mg BID
C. Dabigatran 150 mg BID
D. Apixaban 5 mg BID (or 2.5 mg if ≥2 criteria)
Rationale: Apixaban has the least renal excretion and is approved for CrCl as low
as 15 mL/min. Rivaroxaban and dabigatran are not recommended if CrCl <30
mL/min.
, 3. A patient on atorvastatin 80 mg develops myalgia and CK 6x ULN. LDL
remains 100 mg/dL. Best next step?
A. Switch to rosuvastatin 40 mg
B. Add ezetimibe 10 mg daily
C. Reduce atorvastatin to 40 mg
D. Add bempedoic acid
Rationale: Statin intolerance with CK elevation → add non-statin lipid-lowering
agent. Ezetimibe is first-line add-on before bempedoic acid or PCSK9i per 2026
guidelines.
4. Which drug is contraindicated within 48 hours of tPA in acute ischemic
stroke?
A. Aspirin
B. Clopidogrel
C. Warfarin
D. Apixaban
Rationale: Warfarin (especially with INR >1.7) is excluded from tPA eligibility.
DOACs may be given if last dose >48 hours and normal renal function.
5. First-line antiarrhythmic for vagally mediated atrial fibrillation?
A. Amiodarone
B. Disopyramide
C. Dofetilide
D. Flecainide
Rationale: Disopyramide has anticholinergic effects, useful in vagal AF.
Flecainide is preferred for adrenergic AF.
6. A patient on lisinopril 40 mg develops angioedema. Best alternative in
HFrEF?
A. Losartan
B. Sacubitril/valsartan
C. Aliskiren
D. Hydralazine
Rationale: ARNI (sacubitril/valsartan) is preferred over ARB if previous ACEi
angioedema, but caution — ARNI is contraindicated if angioedema occurred
within 4 weeks of ACEi.
