1. Heart Failure
By Alaina Darby

2. An elderly patient with NYHA functional class IV heart failure is taking furosemide 120 mg PO twice daily. He takes his furosemide at 8 am and 12 noon. He has several conditions and takes many medications. The prescriber requests that the pharmacist calculate the dose of bumetanide that would be equivalent to the patient’s furosemide therapy. Choose the correct equivalent bumetanide dose: A. Bumetanide 2 mg daily B. Bumetanide 4 mg daily C. Bumetanide 6 mg daily D. Bumetanide 8 mg daily E. Bumetanide 10 mg daily

3. Which of the following are common causes of heart failure
Which of the following are common causes of heart failure? (Select ALL that apply.) A. Bipolar disorder B. Stroke C. Myocardial infarction D. Long-standing hypertension E. MRSA infection

4. Which of the following potassium chloride formulations can be opened and sprinkled on food?   A. Micro-K B. Klor-Con C. Klor-Con M10 D. K-tab E. Klor-Con M15

5. A patient gave the pharmacist a prescription for BiDil 20 mg TID
A patient gave the pharmacist a prescription for BiDil 20 mg TID. Which of the following is an appropriate generic substitution for BiDil? A. Isosorbide dinitrate/hydralazine B. Spironolactone C. Isosorbide mononitrate/hydralazine D. Digoxin E. Valsartan/sacubitril

6. A patient with systolic heart failure has been given a prescription for BiDil. Which of the following side effects is most common with BiDil therapy?   A. Rash B. Headache C. Hair growth D. Sore, painful joints E. Increased appetite

7. HA has been prescribed furosemide
HA has been prescribed furosemide. The following may occur from the use of this drug: (Select ALL that apply.)   A. Increased uric acid B. Increased blood glucose C. Increased potassium D. Increased calcium E. Increased triglycerides

8. GV is a systolic heart failure patient on carvedilol 12
GV is a systolic heart failure patient on carvedilol 12.5 mg twice daily. To improve medication adherence, the primary physician wants to convert him to the once daily Coreg CR. What is the equivalent daily dose of Coreg CR for this patient? A. 10 mg B. 20 mg C. 40 mg D. 80 mg E. 160 mg

9. A patient with NYHA functional class III heart failure is diagnosed with diabetes. She is started on metformin but has diarrhea and discontinues the drug. The physician must choose an alternative agent for treatment of her diabetes. Which of the following diabetes medications is contraindicated in this patient?   A. Glimepiride B. Glipizide C. Canagliflozin D. Pioglitazone E. Sitagliptin

10. KG has been diagnosed with heart failure and is beginning carvedilol immediate-release. He is 5 feet, 7 inches and weighs 78 kg. Assuming he tolerates the dose titrations, what is the maximum dose of carvedilol immediate-release that KG should be given? A mg BID B. 25 mg BID C. 50 mg BID D. 75 mg BID E. 100 mg BID

11. Select the correct indication for BiDil: A
Select the correct indication for BiDil:   A. For the treatment of heart failure as initial therapy in self-identified black patients. B. For the treatment of heart failure as an adjunct to standard therapy in self-identified black patients. C. For the treatment of hypertension as an adjunct to standard therapy in self-identified black patients. D. For the treatment of hypertension as initial therapy in self-identified black patients. E. For the treatment of benign prostatic hyperplasia in self-identified black patients.

12. The most effective diuretics for controlling fluid volume in patients with heart failure are:   A. Carbonic anhydrase inhibitors B. Thiazide-type diuretics C. Loop diuretics D. Potassium-sparing diuretics E. Osmotic diuretics

13. WR has been using digoxin 0. 125 mg daily for several years
WR has been using digoxin mg daily for several years. During this time his renal function has declined from an estimated 55 mL/min to 24 mL/min. WR is unable to stand and has vomited and his heart rate is found to be 45 BPM with an abnormal heart rhythm. The cardiologist is paged, but in the meantime the attending physician asks if there are any products that can lower the digoxin level quickly. What is the antidote for digoxin?   A. Dextrose B. Fabior C. DigiFab D. Digox E. Ferriprox

14. Select the correct mechanism of action for valsartan: A
Select the correct mechanism of action for valsartan:   A. Binds to the Na+/K+ ATPase pump and decreases its action B. Aldosterone receptor antagonist C. Binds to beta-adrenergic receptors and blocks epinephrine and norepinephrine D. Blocks angiotensin II by binding directly to the AT1 receptor E. Blocks the conversion of angiotensin I to angiotensin II

15. A patient with heart failure comes to the community pharmacy asking for help choosing a medicine to treat her mild pain. Which of the following is a safe, over-the-counter analgesic to recommend for this patient? A. Tylenol B. Aleve C. Advil D. Celebrex E. Indomethacin

16. A patient with systolic heart failure is taking ramipril, digoxin, carvedilol and furosemide. He has been diagnosed with HIV and prescribed clarithromycin for MAC prophylaxis. Choose the correct statement:   A. The digoxin level will decrease; it is best not to use a P450 3A4 enzyme inducer such as clarithromycin. B. The digoxin level will increase; it is best not to use a P-glycoprotein and 3A4 inhibitor such as clarithromycin. C. Digoxin levels are not affected by hepatic inducers or inhibitors. D. Clarithromycin will bind to digoxin in the gut and reduce absorption. E. Digoxin will cause the clarithromycin level to increase which can cause QT prolongation.

17. Which of the following statements is/are correct regarding treatment with furosemide? (Select ALL that apply.)   A. furosemide should be taken in the morning or early afternoon to avoid getting up at night to go to the bathroom. B. Potassium supplementation is often required when loop diuretics are taken. C. Loop diuretics decrease mortality in patients with heart failure. D. Patient taking furosemide must have their renal function monitored. E. Patients taking oral furosemide can be converted to IV furosemide in a 1:1 ratio.

18. A patient with New York Heart Association (NYHA) functional class III heart failure is diagnosed with rheumatoid arthritis (RA). The physician must choose an agent to treat the RA. Which of the following medications would be most appropriate in this patient?   A. Certolizumab B. Infliximab C. Methotrexate D. Etanercept E. Rituximab

19. Select the correct mechanism of action for spironolactone: A
Select the correct mechanism of action for spironolactone:   A. Binds to beta-adrenergic receptors and blocks epinephrine and norepinephrine B. Blocks angiotensin II by binding directly to the AT1 receptor C. Blocks the conversion of angiotensin I to angiotensin II D. Inhibitor of the Na+/K+ ATPase pump E. Non-selective aldosterone receptor antagonist

20. JB has a past medical history significant for systolic heart failure and hypertension. He is being seen in clinic for routine follow up. He is on quinapril 20 mg BID, metoprolol succinate 200 mg daily, furosemide 20 mg twice daily, and spironolactone 25 mg daily. His blood pressure has been averaging 154/94 mmHg and his heart rate is averaging 65 BPM. Which of the following agents would be best to add to provide better control of his blood pressure? A. Amlodipine B. Diltiazem C. Losartan D. Eplerenone E. Carvedilol

21. Select the correct mechanism of action for lisinopril: A
Select the correct mechanism of action for lisinopril:   A. Binds to the Na+/K+ ATPase pump and decreases its action B. Aldosterone receptor antagonist C. Blocks the conversion of angiotensin I to angiotensin II D. Blocks angiotensin II by binding directly to the AT1 receptor E. Binds to beta-adrenergic receptors and blocks epinephrine and norepinephrine

22. EG has NYHA functional class III systolic heart failure
EG has NYHA functional class III systolic heart failure. The cardiologist is considering beginning eplerenone, in addition to her other medications. He checks her lab values and finds the following: Na 151 mEq/L, K 5.6 mEq/L, Cl 99 mEq/L, HCO3 22 mEq/L, BUN 39 mg/dL and serum creatinine 1.8 mg/dL. Can eplerenone be initiated?   A. Yes, once she is classified as NYHA Class IV. B. Yes, once she has trouble breathing without exertion. C. No, eplerenone is contraindicated. D. Yes, but she will require sodium monitoring. E. Yes, but she will require potassium monitoring.

23. Which of the following beta-adrenergic blocking agents has been shown to reduce mortality in patients with systolic heart failure?   A. Carvedilol B. Metoprolol tartrate C. Atenolol D. Propranolol E. Labetalol

24. Select the correct mechanism of action for Entresto: A
Select the correct mechanism of action for Entresto:   A. Binds to beta-adrenergic receptors and blocks epinephrine and norepinephrine B. Blocks angiotensin II by binding directly to the AT1 receptor C. Blocks the conversion of angiotensin I to angiotensin II D. Blocks neprilysin and the actions of angiotensin II at the receptor site E. Blocks hyperpolarization-activated cyclic nucleotide-gated channels in the sinus node

25. AP has been prescribed furosemide
  AP has been prescribed furosemide. He should be counseled regarding the following side effects from the use of this drug: (Select ALL that apply.)   A. Hypercalcemia B. Hypokalemia C. Photosensitivity D. Orthostatic hypotension E. Hypouricemia

26. FL has been diagnosed with heart failure and is beginning metoprolol extended-release. The pharmacist should provide the following counseling points: (Select ALL that apply.) A. If you miss a dose, take the dose as soon as you remember, unless it is time to take the next dose. Do not double the dose. B. Do not drive a car, use machinery, or do anything that requires being alert until the medication is adjusted and the symptoms subside. C. This medication may cause you to feel more tired and dizzy at first. These effects will go away in a few days. Call a healthcare provider if the symptoms feel severe or if you experience weight gain or increased shortness of breath. D. This medication must be taken 1 hour before meals on an empty stomach. E. This medication should not be stopped abruptly.

27. Choose the correct mechanism of action for carvedilol: A
Choose the correct mechanism of action for carvedilol:   A. Beta-1 and beta-2 blocker and dopamine blocker B. Beta-1 and beta-2 blocker and norepinephrine reuptake inhibitor C. Beta-1 and beta-2 blocker and alpha-1 blocker D. Beta-2 and alpha-2 selective blocker E. Beta-1 and alpha-1 selective blocker

28. The labeling for each of these medications includes a warning regarding cross-sensitivity with sulfa allergy EXCEPT:   A. Ethacrynic acid B. Torsemide C. Bumetanide D. Glipizide E. Furosemide

29. Which of the following statements is correct regarding digoxin. A
Which of the following statements is correct regarding digoxin? A. Digoxin is a positive inotrope and a negative chronotrope. B. Digoxin is a positive inotrope and a positive chronotrope. C. Digoxin is a negative inotrope and a negative chronotrope. D. Digoxin is a negative inotrope and a positive chronotrope. E. Digoxin has no effects on these hemodynamic parameters.

30.   Which of the following antiarrhythmics should be avoided in patients with systolic heart failure? (Select ALL that apply.)   A. Flecainide B. Mexiletine C. Propafenone D. Procainamide E. Quinidine

31. Content adapted from RxPrep
Questions?
Content adapted from RxPrep