Prescribing Safety Assessment (PSA) Practice Exam

What action should be taken if the initial treatment of acute LVHF is ineffective?

1. Administer Metoprolol

2. Perform a cardiac catheterization

3. Escalate to Isosorbide Mononitrate

4. Transfer to a surgical unit

The correct answer is: Escalate to Isosorbide Mononitrate

In the management of acute left ventricular heart failure (LVHF), if the initial treatment proves ineffective, it is critical to escalate therapy to optimize patient outcomes. Isosorbide Mononitrate, a vasodilator, is commonly used in heart failure management to reduce preload and alleviate symptoms. By escalating to this nitrate therapy, the aim is to improve hemodynamics and relieve symptoms such as pulmonary congestion, making it a suitable next step in treatment. In contrast, while Metoprolol is a beta-blocker and can be beneficial in chronic heart failure management, initiating it during an acute exacerbation may not provide the immediate relief needed. Cardiac catheterization, although it can be informative, is not typically a first-line response in managing acute decompensated heart failure unless there is a specific indication for ischemia or intervention. Transferring to a surgical unit may be warranted in certain severe cases but is usually not the appropriate immediate action for ineffective pharmacological treatment. Thus, escalating treatment with Isosorbide Mononitrate is a well-supported choice based on its role in managing acute heart failure symptoms.