View Exam | PowerPak

1. Which of the following are classic sign(s) of heart failure (HF):

A. Dyspnea at rest or with exertion B. Orthopnea C. Edema D. All of the above

2. Which of the following clinical decisions is evidence-based:

A. Addition of combination hydralazine (HYD) and isosorbide dinitrate (ISDN) to standard therapy in an African-American patient with asymptomatic HF to prevent progression of disease B. Addition of combination HYD-ISDN to standard therapy in a Caucasian patient with moderate symptoms and systolic HF to reduce the risk of morbidity and mortality C. Addition of digoxin 0.250 mg daily for a Caucasian patient with mild-to-moderate symptoms and diastolic HF to reduce the risk of mortality D. Addition of combination HYD-ISDN to standard therapy in an African-American patient with severe dyspnea with mild activity and systolic HF to reduce the risk of morbidity and mortality

3. Risk factors for developing HF in African-American patients include which of the following:

A. Uncontrolled and/or resistant hypertension B. High prevalence and severity of risk factors for diabetes and chronic kidney disease C. Lower socioeconomic status and educational level that may decrease access to care D. All of the above

4. Which of the following is an appropriate laboratory or therapeutic intervention at this time: (case)

A. Check serum digoxin level for therapeutic goal of 1.2 to 2.0 ng/mL B. Order N-terminal pro-BNP to correlate biomarker for congestion with clinical signs of increased congestion and fluid/volume overload C. Order cardiac troponin T to correlate biomarker with clinical signs of congestion D. None of the above interventions are clinically indicated

5. HM's physical exam shows positive jugular venous pressure, 1+ pitting edema, normal S1 and S2 heart sounds, and mild crackles at the bases in the lungs, bilaterally. Which of the following is the best pharmacologic intervention for HM at this time: (case)

A. Hold angiotensin-converting enzyme (ACE) inhibitor since blood pressure is controlled and serum creatinine is elevated B. Add spironolactone 25 mg daily for added outcomes benefit since he has systolic HF and is symptomatic C. Give intravenous (IV) Lasix to alleviate congestive symptoms and evidence of fluid retention D. Add HYD-ISDN to alleviate symptoms and to reduce the risks of rehospitalization and mortality

6. HM was given furosemide 40 mg IV in the Emergency Department and admitted. Which of the following is an appropriate clinical intervention at this time? (case)

A. Add eplerenone 25 mg daily and increase to 50 mg daily after 4 weeks if K+ remains < 5 mEq/L and renal function is stable B. Add eplerenone 25 mg every other day and increase to 25 mg daily after 4 weeks if K+ remains < 5 mEq/L and renal function is stable C. Discontinue furosemide at discharge since patient will be at dry weight D. None of the above are appropriate clinical measures at this time

7. Two days later, HM's dyspnea is relieved and he has no clinical evidence of fluid retention. He is sleeping on 2 pillows and experiences only mild shortness of breath with exertion. HM's LVEF is 35% on echocardiogram and he is planned for discharge. Which of the following are appropriate considerations for the pharmacist at discharge? (case)

A. Decrease metoprolol succinate ER dose from 200 mg daily to 150 mg daily because of concerns for hypotension and bradycardia in this patient B. Counsel about avoiding the use of non-steroidal anti-inflammatory drugs/COX-2 inhibitors for pain C. Ensure follow-up appointment and check renal function and serum potassium level within 2 to 3 days to follow the strict monitoring guideline recommendation D. B and C

8. Which of the following is TRUE regarding the management of chronic HF in African-American patients:

A. The addition of HYD-ISDN was shown in a clinical trial to improve LVEF and all-cause mortality in self-identified African-American patients with mild-to-severe symptoms of HF B. The addition of HYD-ISDN was shown in a clinical trial to improve health-related quality of life and all-cause mortality in self-identified African-American patients with moderate-to-severe symptoms of HF C. Digoxin was shown in a clinical trial to improve LVEF, exercise tolerance, and all-cause mortality in self-identified African-American patients with moderate-to-severe symptoms of HF D. Based on evidence-based guidelines, ACE inhibitors are not recommended in self-identified African-American patients with symptomatic systolic HF because of lack of efficacy and increased risk in this population

9. Which of the following is NOT a challenge in the management of patients with HF, considering current trends and the costly disease burden of HF:

A. Possible biological differences across racial/ethnic groups and an incomplete understanding of the different pathophysiology and etiology of HF among patient groups B. Lower incidence of HF in younger AA patients compared with similar aged white patients C. Underutilization of evidence-based medicines, especially in high-risk patient populations D. Inconsistent adoption of guideline recommendations by health care providers

10. Pharmacists' roles in the management of HF include which of the following:

A. Dose optimization and titration to the maximally tolerable doses that were shown to be effective in large clinical trials B. Early identification and prevention, screening, or risk factor modification in high-risk patient groups C. Promotion of adherence to diet and sodium restriction and smoking cessation, if applicable D. All of the above