Heart Failure Pharmacology (30 High-Yield Questions)

HF-001 • Question 1

Which medication class provides a proven mortality benefit in HFrEF and is now considered foundational therapy (one of the '4 pillars')?

Loop diuretics SGLT2 inhibitors Digoxin Nitrates (alone) Hydralazine (alone)

HF-002 • Question 2

Which beta blockers have strong mortality benefit evidence in chronic HFrEF?

Propranolol, nadolol, timolol Metoprolol succinate, carvedilol, bisoprolol Atenolol, labetalol, nebivolol Esmolol, sotalol, pindolol None—beta blockers are contraindicated in HF

HF-003 • Question 3

A patient with HFrEF is switched from an ACE inhibitor to sacubitril/valsartan. What is required to reduce angioedema risk?

No washout needed 12-hour washout 24-hour washout 36-hour washout 7-day washout

HF-004 • Question 4

Which drug is most likely to improve symptoms (diuresis) quickly in acute decompensated heart failure but does NOT provide a mortality benefit by itself?

Furosemide Carvedilol Spironolactone Sacubitril/valsartan Empagliflozin

HF-005 • Question 5

Which medication is most associated with gynecomastia and hyperkalemia in HFrEF therapy?

Hydrochlorothiazide Spironolactone Furosemide Hydralazine Amlodipine

HF-006 • Question 6

A patient with HFrEF has persistent symptoms despite ACEi/ARB/ARNI + beta blocker + MRA. Resting HR is 78 bpm in sinus rhythm. Which add-on targets the SA node 'funny' channel to reduce hospitalization?

Amiodarone Ivabradine Digoxin Verapamil Hydralazine

HF-007 • Question 7

Which vasodilator combo has mortality benefit specifically in Black patients with HFrEF (or when ACEi/ARB/ARNI cannot be used)?

Nitroglycerin + verapamil Hydralazine + isosorbide dinitrate Amlodipine + hydrochlorothiazide Losartan + spironolactone Dobutamine + nitroprusside

HF-008 • Question 8

Which drug provides symptomatic improvement and reduces hospitalizations in HFrEF but has little/no clear mortality benefit and requires level monitoring?

Digoxin Sacubitril/valsartan Carvedilol Empagliflozin Spironolactone

HF-009 • Question 9

A patient on digoxin develops nausea and yellow/green visual changes. Which electrolyte abnormality strongly predisposes to digoxin toxicity?

Hyperkalemia Hypokalemia Hypernatremia Hypercalcemia only Hypophosphatemia

HF-010 • Question 10

Which inotrope is a beta-1 agonist commonly used IV for short-term support in acute decompensated HF with low output and hypotension?

Dobutamine Diltiazem Amiodarone Metoprolol succinate Spironolactone

HF-011 • Question 11

Milrinone increases contractility primarily by inhibiting:

Na+/K+ ATPase Phosphodiesterase-3 (PDE3) Angiotensin converting enzyme If channels Beta-1 receptors directly

HF-012 • Question 12

Which finding best describes HFpEF compared with HFrEF?

Dilated LV with reduced EF Normal or near-normal EF with impaired relaxation/compliance Always caused by valvular stenosis Managed with chronic inotropes Treated with amlodipine as first line

HF-013 • Question 13

Which of the following is NOT one of the classic evidence-based '4 pillars' of chronic HFrEF therapy?

ARNI/ACEi/ARB Evidence-based beta blocker Mineralocorticoid receptor antagonist SGLT2 inhibitor Loop diuretic

HF-014 • Question 14

A patient with HFrEF is newly started on carvedilol. Which counseling point is most appropriate?

Start at high dose for rapid benefit Expect initial fatigue/worsening symptoms; start low and titrate slowly when euvolemic Stop diuretics immediately Carvedilol is for acute pulmonary edema only If HR increases, increase dose immediately

HF-015 • Question 15

Which medication would most likely worsen HFrEF by negative inotropy and is generally avoided in systolic HF?

Verapamil Spironolactone Empagliflozin Sacubitril/valsartan Furosemide

HF-016 • Question 16

A patient with HFrEF and CKD starts an MRA. Which lab abnormality is the biggest safety concern?

Hypercalcemia Hyperkalemia Hypoglycemia Hypernatremia Leukopenia

HF-017 • Question 17

ACE inhibitors improve outcomes in HFrEF primarily by:

Increasing heart rate Blocking aldosterone receptors Reducing afterload and maladaptive RAAS remodeling Increasing calcium entry into myocardium Directly increasing contractility

HF-018 • Question 18

A patient on ACE inhibitor develops cough. A reasonable alternative that maintains RAAS blockade is:

Switch to another ACE inhibitor Switch to an ARB Add a loop diuretic only Stop RAAS blockade permanently Switch to verapamil

HF-019 • Question 19

Which SGLT2 inhibitor pair is commonly used in HF (with or without diabetes) for outcome benefit?

Sitagliptin and saxagliptin Empagliflozin and dapagliflozin Glyburide and glipizide Metformin and pioglitazone Acarbose and miglitol

HF-020 • Question 20

A patient with acute decompensated HF has severe hypertension and pulmonary edema. Which IV drug provides rapid venodilation to reduce preload and improve symptoms?

Nitroglycerin Phenylephrine Epinephrine Verapamil Digoxin

HF-021 • Question 21

Which diuretic strategy is highest yield for loop diuretic resistance in HF?

Increase ACE inhibitor dose only Add a thiazide-type diuretic (e.g., metolazone) for sequential nephron blockade Add verapamil Stop all diuretics and give fluids Switch to amlodipine

HF-022 • Question 22

A 70-year-old with HFrEF and atrial fibrillation needs rate control. Which option is generally preferred for rate control in HFrEF (if tolerated)?

Verapamil Diltiazem Evidence-based beta blocker Nifedipine Propafenone

HF-023 • Question 23

Which adverse effect is most characteristic of SGLT2 inhibitors?

Bradycardia Genital mycotic infections Severe cough Ototoxicity Pulmonary fibrosis

HF-024 • Question 24

A patient with HFrEF is on ACEi, beta blocker, MRA, and SGLT2i. BP is low-normal and still symptomatic. Which agent can reduce hospitalization and may help symptoms by lowering HR if sinus rhythm and HR ≥70?

Ivabradine Amlodipine Hydrochlorothiazide Verapamil Flecainide

HF-025 • Question 25

Which medication is most associated with a dangerous interaction with PDE-5 inhibitors (e.g., sildenafil) due to profound hypotension?

Isosorbide dinitrate Spironolactone Metoprolol succinate Empagliflozin Digoxin

HF-026 • Question 26

A patient with HFrEF is started on an ACE inhibitor. Which change in labs can be acceptable if mild and stable?

K+ rises to 7.2 mEq/L Creatinine rises ~20–30% then stabilizes AST/ALT doubles WBC drops to 2.0 INR rises to 4.5

HF-027 • Question 27

Which of the following is an important reason chronic inotrope infusions are generally avoided outside of palliative/bridge therapy?

They always cause bradycardia They increase arrhythmias and mortality with long-term use They cure cardiomyopathy They are orally bioavailable They reduce afterload more than nitrates

HF-028 • Question 28

Which medication is most likely to be held/avoided during acute decompensated HF with cardiogenic shock and hypotension (until stabilized)?

IV furosemide Nitroglycerin Metoprolol succinate uptitration Oxygen/supportive care Vasopressor/inotrope support

HF-029 • Question 29

A patient with HFrEF cannot tolerate ACEi/ARB/ARNI due to angioedema history. Which alternative regimen is most appropriate to improve outcomes?

Amlodipine monotherapy Hydralazine + isosorbide dinitrate Verapamil + nitrates Digoxin monotherapy Loop diuretic monotherapy

HF-030 • Question 30

Which diuretic adverse effect most increases risk of digoxin toxicity in HF patients?

Hypernatremia Hypokalemia Hypercalcemia Hyperchloremic acidosis Hypermagnesemia