Prescribing Safety Assessment (PSA) Practice Exam

Which medication is typically the first line for managing chronic heart failure?

1. Beta-Blocker - Bisoprolol

2. Ace Inhibitor - Lisinopril

3. Diuretic - Furosemide

4. Spironolactone

The correct answer is: Ace Inhibitor - Lisinopril

The management of chronic heart failure often begins with the use of ACE inhibitors, making Lisinopril a key first-line treatment in this context. ACE inhibitors are well-supported by evidence for their ability to improve symptoms, reduce hospitalizations, and increase overall survival rates in patients with heart failure, particularly those with reduced ejection fraction. Lisinopril works by inhibiting the angiotensin-converting enzyme, which leads to vasodilation and decreased blood pressure, thereby reducing the workload on the heart. This mechanism is crucial for patients with heart failure, as it helps to improve cardiac output and relieve symptoms such as shortness of breath and fatigue. While other medications mentioned, such as beta-blockers and diuretics, are also vital components in the treatment of chronic heart failure, they are typically introduced after the initial stabilization of a patient's condition with an ACE inhibitor. Diuretics, for example, provide symptomatic relief of fluid overload but do not significantly impact mortality. Beta-blockers are important as well but are generally added after initiating an ACE inhibitor. Spironolactone, being an aldosterone antagonist, plays a role in heart failure management, particularly in those with reduced ejection fraction and who are at risk of fluid retention,