Cardiovascular Drugs USMLE Step 1 Practice Question
A 62-year-old man with heart failure (EF 30%) started on carvedilol 2 weeks ago presents with fatigue and orthostatic dizziness. Vital signs: BP 98/62 mmHg (baseline 125/80), HR 52 bpm, RR 16, temp 98.6°F, SpO2 98% on room air. BNP is 250 pg/mL. He denies dyspnea or peripheral edema. Recent echocardiography confirms EF 30% with no acute changes. Which intervention is most appropriate?
Answer choices
- ADiscontinue carvedilol immediately due to intolerance
- BIncrease sodium intake to maintain blood pressure
- CAdd a dihydropyridine calcium channel blocker to offset hypotension
- DReduce the dose and titrate slowly; this is expected with initiationCorrect answer
- ESwitch to a selective beta-1 blocker for better tolerability
- FAdminister IV normal saline bolus and continue current carvedilol dose without modification
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