Cpje Comprehensive Practice
Exam 2026: Drug Therapy &
Patient Care :Questions And
Answers With Rationals/Graded
A+ Update 100% Correct
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-
12)
1. A 68-year-old male with heart failure with reduced ejection fraction (HFrEF,
EF 30%) presents with worsening dyspnea. He is currently on lisinopril 20 mg
daily, carvedilol 25 mg BID, and furosemide 40 mg daily. His blood pressure is
110/70 mmHg, heart rate 68 bpm, potassium 4.5 mEq/L, eGFR 55 mL/min.
Which medication should be added to reduce mortality?
• A) Hydralazine
• B) Digoxin
• C) Sacubitril/valsartan
, • D) Spironolactone
Rationale: Sacubitril/valsartan (ARNI) is preferred over ACE inhibitors in HFrEF to
reduce mortality and hospitalizations. The PARADIGM-HF trial showed superiority
over enalapril. Spironolactone is indicated but typically added when potassium <5.0
mEq/L; however, ARNI has stronger mortality benefit in this optimized patient.
2. A 55-year-old female with paroxysmal atrial fibrillation has CHA₂DS₂-VASc
score of 4. She has moderate mitral stenosis (valve area 1.2 cm²). Which
anticoagulant is most appropriate?
• A) Apixaban
• B) Rivaroxaban
• C) Warfarin (target INR 2-3)
• D) Dabigatran
Rationale: Direct oral anticoagulants (DOACs) are contraindicated in patients with
mechanical heart valves or moderate-to-severe mitral stenosis. Warfarin remains the
standard of care for atrial fibrillation with rheumatic mitral stenosis.
3. A patient on amiodarone for 6 months develops new-onset tremor, weight
loss, and heat intolerance. TSH is undetectable, free T4 elevated. Which test
should be ordered immediately?
• A) Thyroid ultrasound
• B) T3 suppression test
• C) Amiodarone serum level
• D) Cardiac nuclear stress test
Rationale: Amiodarone-induced thyrotoxicosis (Type 1 or Type 2) requires prompt
differentiation. T3 suppression test helps distinguish, but management includes
stopping amiodarone if possible and initiating methimazole or prednisone. This
scenario indicates amiodarone-induced hyperthyroidism.
4. Which statin has the highest potential for drug-drug interaction with
amlodipine?
, • A) Pravastatin
• B) Rosuvastatin
• C) Atorvastatin
• D) Pitavastatin
Rationale: Atorvastatin is metabolized by CYP3A4; amlodipine is a moderate CYP3A4
inhibitor, increasing atorvastatin levels and risk of myopathy. Pravastatin and
pitavastatin are not CYP3A4 substrates.
5. A 72-year-old with hypertension and heart failure is prescribed verapamil for
rate control. One week later, she reports constipation, dizziness, and swollen
ankles. What is the most appropriate action?
• A) Add furosemide
• B) Switch to diltiazem
• C) Increase verapamil dose
• D) Add metoprolol
Rationale: Verapamil causes constipation and peripheral edema more than
diltiazem. Diltiazem is preferred in elderly with HFpEF. Calcium channel blocker-
induced edema responds to dose reduction or switching agents, not diuretics.
6. Which antiplatelet regimen is recommended for a patient 3 months after
drug-eluting stent placement with high bleeding risk (PRECISE-DAPT score
≥25)?
• A) Aspirin + clopidogrel for 12 months
• B) Aspirin + clopidogrel for 6 months then aspirin alone
• C) Ticagrelor monotherapy
• D) Aspirin + prasugrel for 12 months
Rationale: High bleeding risk patients should receive DAPT for 1-3 months after DES
(2023 guidelines suggest 1 month), then aspirin alone. The 2026 focused update
recommends shorter DAPT duration based on bleeding risk stratification.
, 7. A patient taking warfarin for mechanical aortic valve has INR of 4.2 without
bleeding. INR goal is 2.5-3.5. What is the appropriate management?
• A) Hold warfarin for 2 days and restart at lower dose
• B) Reduce warfarin dose by 10-20% and recheck INR in 1 week
• C) Administer vitamin K 2.5 mg orally
• D) Hold warfarin for 1 day and restart same dose
Rationale: For INR 4-5 without bleeding, dose reduction (10-20%) without vitamin K
is recommended. Vitamin K is reserved for INR >10 or bleeding. Mechanical valve
patients should not hold warfarin >24-48 hours due to thrombotic risk.
8. Which beta-blocker is preferred in a patient with asthma and chronic heart
failure?
• A) Propranolol
• B) Metoprolol tartrate
• C) Carvedilol
• D) Atenolol
Rationale: Carvedilol is a non-selective beta-blocker with alpha-1 blocking activity
but has lowest risk of bronchospasm in HF patients with mild asthma due to its
antioxidant and anti-inflammatory properties. However, cardioselective beta-blockers
(metoprolol succinate, bisoprolol) are preferred; carvedilol requires cautious use.
9. A 45-year-old male with recent myocardial infarction is prescribed ezetimibe
10 mg daily in addition to atorvastatin 80 mg daily. LDL is 85 mg/dL. What is
the goal LDL according to 2023 ACC/AHA guidelines?
• A) <100 mg/dL
• B) <70 mg/dL
• C) <55 mg/dL
• D) <40 mg/dL
Exam 2026: Drug Therapy &
Patient Care :Questions And
Answers With Rationals/Graded
A+ Update 100% Correct
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1-
12)
1. A 68-year-old male with heart failure with reduced ejection fraction (HFrEF,
EF 30%) presents with worsening dyspnea. He is currently on lisinopril 20 mg
daily, carvedilol 25 mg BID, and furosemide 40 mg daily. His blood pressure is
110/70 mmHg, heart rate 68 bpm, potassium 4.5 mEq/L, eGFR 55 mL/min.
Which medication should be added to reduce mortality?
• A) Hydralazine
• B) Digoxin
• C) Sacubitril/valsartan
, • D) Spironolactone
Rationale: Sacubitril/valsartan (ARNI) is preferred over ACE inhibitors in HFrEF to
reduce mortality and hospitalizations. The PARADIGM-HF trial showed superiority
over enalapril. Spironolactone is indicated but typically added when potassium <5.0
mEq/L; however, ARNI has stronger mortality benefit in this optimized patient.
2. A 55-year-old female with paroxysmal atrial fibrillation has CHA₂DS₂-VASc
score of 4. She has moderate mitral stenosis (valve area 1.2 cm²). Which
anticoagulant is most appropriate?
• A) Apixaban
• B) Rivaroxaban
• C) Warfarin (target INR 2-3)
• D) Dabigatran
Rationale: Direct oral anticoagulants (DOACs) are contraindicated in patients with
mechanical heart valves or moderate-to-severe mitral stenosis. Warfarin remains the
standard of care for atrial fibrillation with rheumatic mitral stenosis.
3. A patient on amiodarone for 6 months develops new-onset tremor, weight
loss, and heat intolerance. TSH is undetectable, free T4 elevated. Which test
should be ordered immediately?
• A) Thyroid ultrasound
• B) T3 suppression test
• C) Amiodarone serum level
• D) Cardiac nuclear stress test
Rationale: Amiodarone-induced thyrotoxicosis (Type 1 or Type 2) requires prompt
differentiation. T3 suppression test helps distinguish, but management includes
stopping amiodarone if possible and initiating methimazole or prednisone. This
scenario indicates amiodarone-induced hyperthyroidism.
4. Which statin has the highest potential for drug-drug interaction with
amlodipine?
, • A) Pravastatin
• B) Rosuvastatin
• C) Atorvastatin
• D) Pitavastatin
Rationale: Atorvastatin is metabolized by CYP3A4; amlodipine is a moderate CYP3A4
inhibitor, increasing atorvastatin levels and risk of myopathy. Pravastatin and
pitavastatin are not CYP3A4 substrates.
5. A 72-year-old with hypertension and heart failure is prescribed verapamil for
rate control. One week later, she reports constipation, dizziness, and swollen
ankles. What is the most appropriate action?
• A) Add furosemide
• B) Switch to diltiazem
• C) Increase verapamil dose
• D) Add metoprolol
Rationale: Verapamil causes constipation and peripheral edema more than
diltiazem. Diltiazem is preferred in elderly with HFpEF. Calcium channel blocker-
induced edema responds to dose reduction or switching agents, not diuretics.
6. Which antiplatelet regimen is recommended for a patient 3 months after
drug-eluting stent placement with high bleeding risk (PRECISE-DAPT score
≥25)?
• A) Aspirin + clopidogrel for 12 months
• B) Aspirin + clopidogrel for 6 months then aspirin alone
• C) Ticagrelor monotherapy
• D) Aspirin + prasugrel for 12 months
Rationale: High bleeding risk patients should receive DAPT for 1-3 months after DES
(2023 guidelines suggest 1 month), then aspirin alone. The 2026 focused update
recommends shorter DAPT duration based on bleeding risk stratification.
, 7. A patient taking warfarin for mechanical aortic valve has INR of 4.2 without
bleeding. INR goal is 2.5-3.5. What is the appropriate management?
• A) Hold warfarin for 2 days and restart at lower dose
• B) Reduce warfarin dose by 10-20% and recheck INR in 1 week
• C) Administer vitamin K 2.5 mg orally
• D) Hold warfarin for 1 day and restart same dose
Rationale: For INR 4-5 without bleeding, dose reduction (10-20%) without vitamin K
is recommended. Vitamin K is reserved for INR >10 or bleeding. Mechanical valve
patients should not hold warfarin >24-48 hours due to thrombotic risk.
8. Which beta-blocker is preferred in a patient with asthma and chronic heart
failure?
• A) Propranolol
• B) Metoprolol tartrate
• C) Carvedilol
• D) Atenolol
Rationale: Carvedilol is a non-selective beta-blocker with alpha-1 blocking activity
but has lowest risk of bronchospasm in HF patients with mild asthma due to its
antioxidant and anti-inflammatory properties. However, cardioselective beta-blockers
(metoprolol succinate, bisoprolol) are preferred; carvedilol requires cautious use.
9. A 45-year-old male with recent myocardial infarction is prescribed ezetimibe
10 mg daily in addition to atorvastatin 80 mg daily. LDL is 85 mg/dL. What is
the goal LDL according to 2023 ACC/AHA guidelines?
• A) <100 mg/dL
• B) <70 mg/dL
• C) <55 mg/dL
• D) <40 mg/dL
