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ACNP I Midterm Exam - Questions & Solutions (Pass!)
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ACNP I Midterm Exam - Questions & Solutions (Pass!)
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ACNP I Midterm Exam - Questions & Solutions (Pass!)Stage A: At-Risk for Heart Failure Right Ans - HF Stage _____
Pts. at risk w/o current or previous s/s of HF and w/o structural/functional
heart disease or abnormal biomarkers
Pts. with HTN, CVD, diabetes, obesity, exposure to cardiotoxic agents, genetic
variant/family history for cardiomyopathy
Stage B: Pre-Heart Failure Right Ans - HF Stage ______
Pts. w/o current or previous s/s of HF but evidence of 1 of the following:
-structural heart disease
-increased filling pressures
-risk factors and increased natriuretic peptide levels OR persistently elevated
cardiac troponin in the absence of competing diagnoses
Stage C: Symptomatic Heart Failure Right Ans - HF Stage ______
Pts. with current or previous s/s of HF
Stage D: Advanced Heart Failure Right Ans - HF Stage ______
Marked HF symptoms that interfere with daily life and with recurrent
hospitalizations despite attempts to optimize GDMT
NYHA Functional Classification: I Right Ans - NYHA Functional Class ______:
No limitation of physical activity. Ordinary physical activity does not cause
symptoms of HF
NYHA Functional Classification: II Right Ans - NYHA Functional Class ______:
Slight limitation of physical activity. Comfortable at rest, but ordinary physical
activity results in symptoms of HF
NYHA Functional Classification: III Right Ans - NYHA Functional Class
______:
,Marked limitation of physical activity. Comfortable at rest, but less than
ordinary activity causes symptoms of HF
NYHA Functional Classification: IV Right Ans - NYHA Functional Class
______:
Unable to carry on any physical activity without symptoms of HF, or
symptoms of HF at rest
SGLT2 Inhibitors Right Ans - Used for treatment of type 2 DM, found to
benefit those with HF (reduced hospitalizations and death)
SGLT2 inhibitors Right Ans - Dapaglifozin, Empaglifozin
SGLT2 inhibitors Right Ans - -Used with EF < 40%
-Appropriate for NYHA class II-IV
-Contraindicated in type 1 DM (increased risk ketoacidosis)
SGLT2 inhibitors Right Ans - -Blocks SGLT2 protein in the proximal tubule
of the nephron, reducing the amount of reabsorbed glucose and sodium into
the blood
-Results in glycosuria, resulting in natriuresis and diuresis
True Right Ans - T/F: ARNI is superior to ARB
ARNI Right Ans - Valsartan/sacubril (Entresto)
ARNI Right Ans - Recommended as first line therapy for chronic HF NYHA
class II-IV in patients who have access to this drug class
ARNI Right Ans - Do not administer with ACEI or within 36 hours of last
ACEI dose or to patients with history of angioedema
Valsartan component of Entresto Right Ans - Component of this drug has
black box warning for fetal toxicity
Isosorbide + hydralazine (Bidil) Right Ans - -Venodilator + arteriodilator
, Reduces morbidity and mortality in patients who identify as black with class
III-IV HFrEF who are on optimal doses of ACEI/ARB and BB, unless
contraindicated
Ivabradine (Corlanor) Right Ans - Selectively inhibits the current in the SA
node and reduces HR
· Does not affect myocardial contractility
· Inhibits If (HCN) channels (mixed sodium=potassium channels)
Ivabradine (Corlanor) Right Ans - Indicated for:
· Sinus rhythm with a HR > or = 70 BPM
· Patients on maximally tolerated doses of GMDT meds
· Adjunct therapy for chronic, stable HFrEF (EF < 35%)
Digoxin Right Ans - -Can be considered for all patients with HFrEF who
have not responded symptomatically to other GDMT
-Does not affect mortality
-Commonly initiated and maintained at a dose of 0.125 to 0.25 mg daily
Digoxin Right Ans - Caution if stopping - withdrawal can lead to worsening
HF symptoms
Aldosterone antagonists Right Ans - Spironolactone, Eplerenone
Aldosterone antagonists Right Ans - Do not use if GFR < 30 mL/min/1.73
m2 or if potassium > 5.0 mEq/dL
Vericiguat Right Ans - For high risk patients with HFrEF on optimal GDMT
to reduce hospitalizations and death
-Oral soluble guanylyl cyclase stimulator
-Increases cGMP production
Omega-3 polyunsaturated fatty acid (PUFA) supplementation Right Ans -
Reasonable to use as adjunctive therapy to reduce mortality and
hospitalizations in patients with HF class II-IV with symptoms
Potassium binders Right Ans - Sodium polystyrene sulfonate (Kayexalate)
Patiromer (Veltassa)
Sodium zirconium cyclosilicate (Lokelma)
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