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2024 NAPLEX CARDIOLOGY REVIEW EXAM WITH CORRECT ANSWERS
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2024 NAPLEX CARDIOLOGY REVIEW EXAM WITH CORRECT ANSWERS
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2024 NAPLEX CARDIOLOGYREVIEW EXAM WITH CORRECT
ANSWERS
What is the definition of hypertension? - CORRECT-ANSWERSBP > 140/90
OR
Patient requires antihypertensive therapy
What is the specific MOA of spironolactone? - CORRECT-ANSWERSNON-
selective ARA = blocks aldosterone receptor, but also blocks androgen and
progesterone receptors, which is thus associated with endocrine side effects
What is the specific MOA of eplerenone? - CORRECT-ANSWERSSELECTIVE
ARA = binds the aldosterone receptor only (not associated with endocrine
side effects)
What are contraindications to use of the ARAs? - CORRECT-ANSWERS1) K > 5
mEq/L
2) SCr >2.5 mg/dL
3) CrCl < 30 mL/min
4) Concomitant ACE and ARB use (shouldn't happen)
What is a specific contraindication for eplerenone? - CORRECT-ANSWERSUse
of strong CYP3A4 inhibitors (Ritonavir, ketoconazole, itraconazole,
nefazodone, clarithromycin, etc.)
What is a common side effects for both ARAs? - CORRECT-
ANSWERSHyperkalemia
What side effects are specific to spironolactone? - CORRECT-ANSWERS1)
Gynecomastia
2) Breast tenderness
3) Menstrual changes
4) Hirsutism (can also be used to treat hirsutism)
What agents should you NOT use ARAs with? - CORRECT-ANSWERS1) ACEIs
or ARBs
2) NSAIDs
3) K supplements
Note: All increase hyperkalemia risk
,T/F: ARAs reduce mortality in heart failure patients. - CORRECT-
ANSWERSTrue!
What is epleronone's typical place in therapy? - CORRECT-ANSWERSUsed in
patients that develop bothersome endocrine side effects to spironolactone
What 3 ARBs are used in heart failure? - CORRECT-ANSWERS1) Candesartan
(Atacand)
2) Losartan (Cozaar)
3) Valsartan (Diovan)
Which 2 ARBs are actually approved for use in heart failure? - CORRECT-
ANSWERSCandesartan and Valsartan
T/F: ARBs should be considered equivalent to ACEIs in setting of heart failure.
- CORRECT-ANSWERSFalse. Should NOT be considered equivalent or superior
to ACEIs.
There are 2 vasodilators commonly used for heart failure. What are they? -
CORRECT-ANSWERS1) Hydralazine = only available generically (40-300
mg/day)
2) Isosorbide dinitrate = Isordil (30-120 mg/day)
What is the mechanistic difference between these two vasodilators? -
CORRECT-ANSWERSHydralazine = arterial vasodilator (decreased afterload)
Isordil = venous vasodilator (decreases preload)
T/F: There are no true contraindications to either of these vasodilators other
than drug allergies. - CORRECT-ANSWERSTrue.
What are side effects (think logically)? - CORRECT-ANSWERS1) Headache
2) Dizziness
3) Reflex tachycardia
4) Peripheral edema (hydralazine)
5) Lupus-like syndrome (hydralazine)
T/F: When used together, hydralazine and Isordil can decrease mortality in
heart failure. - CORRECT-ANSWERSTrue.
What happens when hydralazine is used alone in heart failure? - CORRECT-
ANSWERSIncreased mortality
When is the combination of these 2 vasodilators commonly used in heart
failure? - CORRECT-ANSWERSWhen ACE or ARB cannot be tolerated due to
renal insufficiency, hyperkalemia, and/or angioedema
,Is there a combo product with both vasodilators in it? - CORRECT-
ANSWERSYes. BiDil.
There are 3 intravenous vasodilators that can be used for heart failure. What
are they? - CORRECT-ANSWERS1) Nitroglycerin (NTG)
2) Nitroprusside
3) Nesiritide
What is the MOA of nitroglycerin? - CORRECT-ANSWERSIs a potent venous
vasodilator, and thereby decreases preload. Can also cause arterial
vasodilation, but only at high doses.
What are side effects of NTG? - CORRECT-ANSWERS1) Hypotension
2) Tachycardia
3) Headache
4) Tolerance
In what HF patients is NTG especially useful? - CORRECT-ANSWERSThose
with myocardial ischemia
How do you overcome tolerance to NTG? - CORRECT-ANSWERSIncrease
infusion rate
What is the MOA of nitroprusside? - CORRECT-ANSWERSArterial and venous
vasodilator, thereby decreasing BOTH preload and afterload
What are side effects of nitroprusside? - CORRECT-ANSWERS1) Hypotension
2) Cyanide/Thiocyanate toxicity
3) N/V
What makes risk of cyanide toxicity with nitroprusside greater? - CORRECT-
ANSWERSIf infusion lasts longer than 24 hours
In what patients should nitroprusside be avoided? - CORRECT-
ANSWERSThose with renal dysfunction (if they don't clear it appropriately,
the risk for cyanide toxicity climbs)
What is the MOA of nesiritide? - CORRECT-ANSWERSArterial and venous
vasodilator, which decreases BOTH preload and afterload
Note: is B-type natriuretic peptide (BNP)
What are side effects of nesiritide? - CORRECT-ANSWERS1) Hypotension
2) Headache
, What are titration instructions regarding nesiritide? - CORRECT-ANSWERSDo
not titrate more quickly than every 3 hours
There are 3 intravenous positive inotropes commonly used in heart failure.
What are they? - CORRECT-ANSWERS1) Dopamine
2) Dobutamine
3) Milrinone
Dopamine has a simple MOA, but it binds different receptors at different
doses. How so? - CORRECT-ANSWERS0.5-3 mcg/kg/min = agonizes dopamine
receptors and increases urine output
3-10 mcg/kg/min = agonizes beta-1 receptors and increases heart rate and
cardiac output
>10 mcg/kg/min = agonizes alpha-1 receptors and increases blood pressure
What are the side effects of dopamine? - CORRECT-ANSWERS1) Arrhythmias
2) Tachycardia
3) Myocardial ischemia
4) N/V
When should dopamine be avoided? - CORRECT-ANSWERSIn patients with
myocardial ischemia
What is the MOA of dobutamine? - CORRECT-ANSWERSBeta-1 and Beta-2
receptor agonist and weak alpha-1 receptor agonist, which leads to
increased CO and some vasodilation
What are side effects of dobutamine? - CORRECT-ANSWERS1) Arrhythmias
2) Tachycardia
3) Myocardial ischemia
4) Hypokalemia
5) Tremor
When should dobutamine be avoided? - CORRECT-ANSWERS1) In patients
with myocardial ischemia
2) In patients on chronic beta blocker therapy
3) Tolerance can develop
What is the MOA of milrinone? - CORRECT-ANSWERSPDE III inhibitor, which
leads to increased cardiac output and vasodilation
What is the cardiac output formula? - CORRECT-ANSWERSHR x SV
What are the side effects of milrinone? - CORRECT-ANSWERS1) Hypotension
2) Arryhthmias
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