Cardiovascular medication management in the hospital is a high-stakes, dynamic field where pharmacists play a critical role in optimizing patient outcomes. Unlike community practice, the inpatient setting often involves managing acute, life-threatening events like Acute Coronary Syndromes (ACS) and acutely decompensated heart failure, requiring the expert use of potent intravenous medications. As a PharmD student, your curriculum, particularly courses like Patient Care 3: Introduction to Cardiovascular and Pulmonary Disease and the Professional Skills Lab 3, is designed to build your competency in this area. This quiz will test your knowledge on initiating and managing complex cardiovascular therapies, from antiplatelet and anticoagulant regimens to the use of IV diuretics and vasoactive drips, all essential skills for the hospital pharmacist.
1. A patient presents to the emergency department with a STEMI. In addition to aspirin, which of the following is a standard component of initial management?
- a. Immediate administration of an IV P2Y12 inhibitor.
- b. A high-intensity statin.
- c. An IV ACE inhibitor.
- d. An oral anticoagulant.
Answer: a. Immediate administration of an IV P2Y12 inhibitor.
2. In a patient with acute decompensated heart failure who is “warm and wet” (euvolemic but with signs of congestion), which class of IV medication is most appropriate to reduce preload?
- a. Inotropes (e.g., dobutamine)
- b. Vasodilators (e.g., nitroglycerin)
- c. Beta-blockers
- d. ACE inhibitors
Answer: b. Vasodilators (e.g., nitroglycerin)
3. When initiating a continuous infusion of unfractionated heparin (UFH) for the treatment of a pulmonary embolism, which lab parameter is used for monitoring its therapeutic effect?
- a. Prothrombin Time (PT)
- b. International Normalized Ratio (INR)
- c. Activated Partial Thromboplastin Time (aPTT)
- d. Platelet count
Answer: c. Activated Partial Thromboplastin Time (aPTT)
4. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. What is the appropriate long-term therapy to recommend upon discharge?
- a. Aspirin 81 mg daily.
- b. No antithrombotic therapy is needed.
- c. Oral anticoagulation.
- d. Dual antiplatelet therapy.
Answer: c. Oral anticoagulation.
5. Which of the following is a potential life-threatening adverse effect of heparin therapy?
- a. Heparin-Induced Thrombocytopenia (HIT)
- b. Rebound hypertension
- c. Severe hyperkalemia
- d. Drug-induced lupus
Answer: a. Heparin-Induced Thrombocytopenia (HIT)
6. For a patient admitted with NSTE-ACS who is undergoing a PCI, how long is dual antiplatelet therapy (DAPT) typically recommended?
- a. 1 month
- b. 3 months
- c. 6 months
- d. At least 12 months
Answer: d. At least 12 months
7. A patient with acute decompensated heart failure and severe fluid overload (e.g., pulmonary edema) would be classified as:
- a. Warm and Dry
- b. Warm and Wet
- c. Cold and Dry
- d. Cold and Wet
Answer: b. Warm and Wet
8. Which of the following is an appropriate agent for rapid rate control of atrial fibrillation in the hospital setting?
- a. Oral amiodarone
- b. IV diltiazem
- c. Oral lisinopril
- d. IV atorvastatin
Answer: b. IV diltiazem
9. A patient is being started on warfarin in the hospital for a new DVT. Why must “bridging” therapy with a parenteral anticoagulant (like heparin or enoxaparin) be used?
- a. Warfarin has a delayed onset of action, and bridging prevents a transient hypercoagulable state.
- b. Warfarin is not effective for DVT.
- c. The parenteral agent increases the INR more quickly.
- d. Bridging is not necessary.
Answer: a. Warfarin has a delayed onset of action, and bridging prevents a transient hypercoagulable state.
10. In the management of ACS, what is the mechanism of action of P2Y12 inhibitors like clopidogrel?
- a. They inhibit the COX-1 enzyme.
- b. They block the binding of ADP to its receptor on platelets, preventing platelet activation.
- c. They are direct thrombin inhibitors.
- d. They inhibit Vitamin K epoxide reductase.
Answer: b. They block the binding of ADP to its receptor on platelets, preventing platelet activation.
11. A patient with decompensated heart failure is receiving a continuous infusion of furosemide. The pharmacist should closely monitor which of the following?
- a. Serum glucose
- b. Urine output and serum electrolytes (K+, Mg++)
- c. Liver function tests
- d. International Normalized Ratio (INR)
Answer: b. Urine output and serum electrolytes (K+, Mg++)
12. The ability to recommend an individualized dosing regimen for heparin and warfarin is a key objective in the Professional Skills Lab 3.
- a. True
- b. False
Answer: a. True
13. A patient who just had a drug-eluting stent placed for ACS should NOT prematurely discontinue which medication class due to the high risk of stent thrombosis?
- a. Statins
- b. Beta-blockers
- c. P2Y12 inhibitors
- d. ACE inhibitors
Answer: c. P2Y12 inhibitors
14. Dobutamine is an IV inotrope used in patients with cardiogenic shock (“cold and wet” heart failure). Its primary effect is to:
- a. Decrease heart rate.
- b. Increase systemic vascular resistance.
- c. Increase cardiac contractility and cardiac output.
- d. Cause significant vasodilation.
Answer: c. Increase cardiac contractility and cardiac output.
15. What is the reversal agent for unfractionated heparin?
- a. Vitamin K
- b. Protamine sulfate
- c. Kcentra (4F-PCC)
- d. Idarucizumab
Answer: b. Protamine sulfate
16. Which of the following is NOT part of the initial MONA-B therapy for suspected ACS?
- a. Morphine
- b. Oxygen (if hypoxic)
- c. Nitroglycerin
- d. Nifedipine
Answer: d. Nifedipine
17. What is a common strategy for managing diuretic resistance in acute decompensated heart failure?
- a. Decreasing the diuretic dose.
- b. Administering the diuretic as a continuous infusion or adding a thiazide-like diuretic (e.g., metolazone).
- c. Restricting the patient’s fluid intake to less than 500 mL/day.
- d. Administering IV fluids.
Answer: b. Administering the diuretic as a continuous infusion or adding a thiazide-like diuretic (e.g., metolazone).
18. For a patient with a new VTE, treatment with warfarin is typically continued until the INR is in the therapeutic range of ____ for at least 24 hours.
- a. 1.0 – 1.5
- b. 1.5 – 2.0
- c. 2.0 – 3.0
- d. 3.0 – 4.0
Answer: c. 2.0 – 3.0
19. Which antiplatelet agent is contraindicated in patients with a history of stroke or TIA?
- a. Aspirin
- b. Clopidogrel
- c. Prasugrel
- d. Ticagrelor
Answer: c. Prasugrel
20. A patient on amiodarone for atrial fibrillation is being started on warfarin. The pharmacist should recommend:
- a. Starting at a higher dose of warfarin.
- b. Starting at a lower dose of warfarin due to a significant drug-drug interaction.
- c. No dose adjustment is needed.
- d. Discontinuing the amiodarone.
Answer: b. Starting at a lower dose of warfarin due to a significant drug-drug interaction.
21. All patients with a history of MI should be discharged on which class of medication indefinitely for secondary prevention?
- a. Nitrates
- b. Statins
- c. Digoxin
- d. Inotropes
Answer: b. Statins
22. “Rate control” as a strategy for atrial fibrillation aims to:
- a. Convert the patient back to normal sinus rhythm.
- b. Keep the ventricular heart rate below a certain goal (e.g., <110 bpm) to improve symptoms.
- c. Eliminate the risk of stroke.
- d. Increase the heart rate.
Answer: b. Keep the ventricular heart rate below a certain goal (e.g., <110 bpm) to improve symptoms.
23. Which of the following is a direct thrombin inhibitor used for anticoagulation in ACS or HIT?
- a. Unfractionated heparin
- b. Enoxaparin
- c. Bivalirudin
- d. Fondaparinux
Answer: c. Bivalirudin
24. The management of atrial fibrillation and VTE are specific topics in the Patient Care 3 course.
- a. True
- b. False
Answer: a. True
25. A patient develops chest pain in the hospital and is given a sublingual nitroglycerin tablet. What is its mechanism of action?
- a. It blocks beta receptors.
- b. It inhibits platelet aggregation.
- c. It causes vasodilation, which reduces myocardial oxygen demand.
- d. It is a negative inotrope.
Answer: c. It causes vasodilation, which reduces myocardial oxygen demand.
26. Which of the following is an absolute contraindication to fibrinolytic therapy in a STEMI patient?
- a. Age > 65
- b. Current anticoagulation with a therapeutic INR
- c. Any prior intracranial hemorrhage
- d. A recent dental procedure
Answer: c. Any prior intracranial hemorrhage
27. In a patient with HFrEF (Heart Failure with reduced Ejection Fraction), which medication class should be started in the hospital once the patient is stable and euvolemic?
- a. NSAIDs
- b. Calcium channel blockers
- c. Beta-blockers
- d. Thiazolidinediones
Answer: c. Beta-blockers
28. What is the role of an aldosterone antagonist (e.g., spironolactone) in a post-MI patient with an EF < 40%?
- a. To provide rate control.
- b. To reduce mortality by preventing cardiac remodeling.
- c. To act as the primary diuretic.
- d. To lower LDL cholesterol.
Answer: b. To reduce mortality by preventing cardiac remodeling.
29. The term “door-to-balloon” time in a STEMI patient refers to the time from hospital arrival to:
- a. Administration of aspirin.
- b. Performance of a percutaneous coronary intervention (PCI).
- c. Discharge from the hospital.
- d. The first dose of a beta-blocker.
Answer: b. Performance of a percutaneous coronary intervention (PCI).
30. The Professional Skills Lab 3 session on this topic is titled “Cardiovascular Medication Management in the Hospital.”
- a. True
- b. False
Answer: a. True
31. IV nitroglycerin infusions require special non-PVC tubing because the drug:
- a. Is not stable in plastic.
- b. Adsorbs to standard PVC plastic tubing, reducing the dose delivered.
- c. Reacts with the plastic to form a toxic compound.
- d. Is too viscous for normal tubing.
Answer: b. Adsorbs to standard PVC plastic tubing, reducing the dose delivered.
32. The primary difference between unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) is that:
- a. UFH requires routine therapeutic monitoring (aPTT), while LMWH generally does not.
- b. LMWH has a higher risk of HIT.
- c. UFH is administered subcutaneously, and LMWH is given IV.
- d. LMWH has a shorter half-life.
Answer: a. UFH requires routine therapeutic monitoring (aPTT), while LMWH generally does not.
33. Which of the following is NOT a goal of therapy in acute decompensated heart failure?
- a. Relieve congestive symptoms.
- b. Optimize volume status.
- c. Initiate oral inotrope therapy for discharge.
- d. Minimize cardiac damage.
Answer: c. Initiate oral inotrope therapy for discharge.
34. A patient admitted for a hypertensive emergency may be treated with which of the following continuous IV infusions?
- a. Nicardipine
- b. Furosemide
- c. Amiodarone
- d. Heparin
Answer: a. Nicardipine
35. Digoxin has a narrow therapeutic index and its levels can be increased by which of the following drugs, requiring careful monitoring?
- a. Atorvastatin
- b. Metformin
- c. Amiodarone
- d. Lisinopril
Answer: c. Amiodarone
36. A pharmacist’s role in hospital anticoagulation management includes:
- a. Recommending initial dosing.
- b. Monitoring INR/aPTT and recommending adjustments.
- c. Providing patient education upon discharge.
- d. All of the above.
Answer: d. All of the above.
37. Ticagrelor (Brilinta) differs from clopidogrel in that it:
- a. Is a prodrug.
- b. Binds reversibly to the P2Y12 receptor.
- c. Has a slower onset of action.
- d. Is less potent.
Answer: b. Binds reversibly to the P2Y12 receptor.
38. Which of the following is a common side effect of loop diuretics like furosemide that requires monitoring in the hospital?
- a. Hyperkalemia
- b. Hypokalemia and hypomagnesemia
- c. Hypercalcemia
- d. Bradycardia
Answer: b. Hypokalemia and hypomagnesemia
39. Before administering a beta-blocker to a patient with ACS, the pharmacist should ensure the patient does not have:
- a. Hypertension
- b. Tachycardia
- c. Signs of acute heart failure or cardiogenic shock.
- d. A history of smoking.
Answer: c. Signs of acute heart failure or cardiogenic shock.
40. A patient’s home medication is Entresto (sacubitril/valsartan). If they are admitted to the hospital, it is important to:
- a. Stop the Entresto and start an ACE inhibitor immediately.
- b. Continue the Entresto if clinically appropriate and available on formulary.
- c. Add an ACE inhibitor to the Entresto.
- d. Switch to a beta-blocker.
Answer: b. Continue the Entresto if clinically appropriate and available on formulary.
41. What is the reversal agent for dabigatran (Pradaxa)?
- a. Protamine
- b. Vitamin K
- c. Idarucizumab (Praxbind)
- d. Andexanet alfa
Answer: c. Idarucizumab (Praxbind)
42. The pharmacology of inotropic agents and neprilysin inhibitors are topics covered in the Patient Care 3 course.
- a. True
- b. False
Answer: a. True
43. A patient with ACS should receive aspirin at what initial dose?
- a. 81 mg, chewable
- b. 162-325 mg, chewable
- c. 500 mg, enteric-coated
- d. 81 mg, enteric-coated
Answer: b. 162-325 mg, chewable
44. A key responsibility for a pharmacist in the hospital is to rationalize the factors that determine appropriate administration of IV medications, such as compatibility and rate of administration.
- a. True
- b. False
Answer: a. True
45. Which of the following electrolytes should be corrected before administering IV potassium to a hypokalemic patient?
- a. Sodium
- b. Calcium
- c. Magnesium
- d. Bicarbonate
Answer: c. Magnesium
46. In a patient with ADHF and diuretic resistance, adding metolazone should be done cautiously due to the high risk of:
- a. Hyperkalemia
- b. Severe electrolyte depletion and hypotension
- c. Bradycardia
- d. Anaphylaxis
Answer: b. Severe electrolyte depletion and hypotension
47. For a patient being discharged on warfarin, what is the most critical counseling point?
- a. The color of the tablets may change between fills.
- b. The importance of consistent dietary Vitamin K intake and the need for routine INR monitoring.
- c. The medication can be taken with or without food.
- d. The medication can cause a dry cough.
Answer: b. The importance of consistent dietary Vitamin K intake and the need for routine INR monitoring.
48. Why would a glycoprotein IIb/IIIa inhibitor (e.g., eptifibatide) be used during a PCI?
- a. To lower blood pressure.
- b. To provide potent, immediate inhibition of platelet aggregation.
- c. To dissolve an existing clot.
- d. To provide long-term anticoagulation.
Answer: b. To provide potent, immediate inhibition of platelet aggregation.
49. Milrinone is a phosphodiesterase inhibitor that acts as an “inodilator,” meaning it:
- a. Increases contractility and increases vascular resistance.
- b. Decreases contractility and decreases vascular resistance.
- c. Increases contractility and decreases vascular resistance.
- d. Decreases contractility and increases vascular resistance.
Answer: c. Increases contractility and decreases vascular resistance.
50. The ultimate goal of a hospital pharmacist in managing cardiovascular medications is to:
- a. Ensure the most expensive therapies are used.
- b. Apply evidence-based guidelines to provide safe and effective therapy that improves patient outcomes.
- c. Discharge patients as quickly as possible.
- d. Prevent any medications from being administered.
Answer: b. Apply evidence-based guidelines to provide safe and effective therapy that improves patient outcomes.