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Heart failure therapy optimisation — UKMLA MCQ

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HardCardiologyHeart failure therapy optimisationUKMLAMRCP Part 1MRCGP AKTPARA

A man with stable HFrEF is benefiting from an ACE inhibitor, beta-blocker, SGLT2 inhibitor and spironolactone, but develops painful gynaecomastia. Potassium and renal function are acceptable. Which medication change should be discussed with the heart-failure prescriber?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Replace spironolactone with eplerenone

Explanation lettering: C = shown as B · D = shown as C · B = shown as D

A is correct. Eplerenone is a mineralocorticoid receptor antagonist with less anti-androgen effect and can preserve the MRA component when spironolactone causes gynaecomastia, subject to renal and potassium monitoring. B does not address the adverse effect. C may worsen systolic heart failure. D removes therapies with prognostic benefit. E neither treats the adverse effect nor provides an equivalent HFrEF regimen.

Reference: NICE NG106: chronic heart failure in adults: https://www.nice.org.uk/guidance/ng106/chapter/Recommendations GMC: PA registration assessment content map: https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/pa-and-aa-prequalification-education-framework/pa-registration-assessment-content-map