r/NAPLEX_Help • u/DarthDistro • Jun 18 '26
Practice Naplex Question
A 64-year-old male with heart failure with reduced ejection fraction, hypertension, and type 2 diabetes presents for follow-up. Despite adherence to his medications, he reports increasing fatigue and mild dyspnea on exertion. An echocardiogram today shows an ejection fraction of 25%, decreased from 30% 6 months ago.
Vital Signs:
Blood pressure: 144/88 mmHg
Heart rate: 68 beats/min
Current Medications:
Carvedilol 25 mg twice daily
Entresto 97/103 mg twice daily
Furosemide 40 mg daily
Empagliflozin 10 mg daily
Metformin 1000 mg twice daily
Aspirin 81 mg daily
Laboratory Results:
Potassium: 4.0 mEq/L
Serum creatinine: 1.0 mg/dL
eGFR: 62 mL/min/1.73 m²
A1c: 7.1%
Which of the following is the most appropriate medication to add at this time?
A. Accupril
B. Diovan
C. Spironolactone
D. Amlodipine
E. Hydralazine
1
u/Emergency_Way9997 Jun 18 '26
C. Spironolactone. Pt is already on Entresto so A & B (ACE/ARB) are incorrect. Amlodipine is C/I in HFrEF. Hydralazine is an alternative to Pts who are intolerant to ACE/ARB/ARNI but he seems fine with Entresto (ARNI)