Cardiovascular Drugs USMLE Step 1 Practice Question
A 72-year-old woman with systolic heart failure (LVEF 30%) initiated on lisinopril and carvedilol presents after 1 month with dyspnea and fatigue. Vital signs: BP 98/62 mmHg, HR 58 bpm, RR 18/min, SpO2 98% on room air. Serum creatinine increased from 1.2 to 1.5 mg/dL; potassium 5.2 mEq/L. Physical examination reveals no new peripheral edema. Which intervention is most appropriate?
Answer choices
- ASwitch lisinopril to a dihydropyridine calcium channel blocker
- BDiscontinue lisinopril immediately to prevent acute kidney injury
- CDecrease carvedilol dose to reduce renal hypoperfusion
- DContinue both medications; a small rise in creatinine is expected and typically stabilizesCorrect answer
- EStart aggressive diuretic therapy to improve renal perfusion
- FReduce carvedilol dose; beta-blockade-mediated reduction in cardiac output impairs renal perfusion in HFrEF
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