Pre-Quiz: Chronic Heart Failure Pharmacotherapy Copy

A 65-year-old male with a history of hypertension, hyperlipidemia, and chronic heart failure presents to the clinic for a routine follow-up. He is currently on lisinopril, carvedilol, and spironolactone. His blood pressure is 130/80 mmHg, heart rate is 70 beats per minute, and respiratory rate is 16 breaths per minute. His physical exam is unremarkable except for bilateral lower extremity edema. His laboratory results show a BNP level of 500 pg/mL (normal range <100 pg/mL) and a serum creatinine level of 1.2 mg/dL (normal range 0.6-1.3 mg/dL).

A 65-year-old African American male with a history of hypertension, diabetes, and chronic heart failure presents to the clinic with worsening shortness of breath and fatigue. His current medications include lisinopril, metformin, metoprolol, eplerenone and furosemide. On physical examination, he has bilateral crackles in his lungs and an elevated jugular venous pressure. His echocardiogram shows an ejection fraction of 30%. Which medication should be added to the patient’s current regimen to reduce mortality in the management of chronic heart failure?

A 65-year-old male with a history of hypertension, diabetes, and chronic heart failure presents to the clinic with worsening shortness of breath and fatigue. His current medications include lisinopril, metformin, and furosemide. On physical examination, he has bilateral crackles in his lungs and jugular venous distension. His blood pressure is 130/80 mmHg, heart rate is 90 beats per minute, and oxygen saturation is 92% on room air. Laboratory results show a B-type natriuretic peptide (BNP) level of 800 pg/mL (normal range <100 pg/mL).  Which medication should be added to the patient’s current regimen to manage chronic heart failure?

A 65-year-old male with a history of hypertension, diabetes, and chronic heart failure presents to the clinic with worsening shortness of breath and fatigue. His current medications include lisinopril 20mg daily, metformin 1000mg twice daily, and furosemide 40mg daily. His blood pressure is 130/80 mmHg, heart rate is 80 beats per minute, and respiratory rate is 20 breaths per minute. His physical exam is significant for bilateral crackles in the lung bases and peripheral edema. Which of the following is the most appropriate pharmacologic therapy for the management of chronic heart failure in this patient?

A 65-year-old male with a history of chronic heart failure presents to the clinic for a routine follow-up. He is currently on a regimen of lisinopril, carvedilol, and spironolactone. His blood pressure is 120/80 mmHg, heart rate is 70 beats per minute, and respiratory rate is 16 breaths per minute. His physical exam is unremarkable. His laboratory results show a serum potassium level of 4.5 mEq/L and a serum creatinine level of 1.2 mg/dL. Which of the following is a potential adverse effect of spironolactone in the management of chronic heart failure?