Heart failure: sacubitril-valsartan: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Heart failure: sacubitril-valsartan

Sample item

Why must an ACE inhibitor be stopped for an interval before sacubitril-valsartan is started?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Combined neprilysin and ACE inhibition can greatly increase angioedema risk

Neprilysin inhibition also increases vasoactive peptides, including bradykinin. Combining it with an ACE inhibitor can cause excessive bradykinin accumulation, so a washout period is required.

Option by option

  • A. Valsartan prevents renal elimination of ACE inhibitors

    The concern is peptide metabolism, not renal drug elimination.

  • B. Combined neprilysin and ACE inhibition can greatly increase angioedema risk (correct)

    Correct. The washout reduces the risk of bradykinin-mediated angioedema.

  • C. Sacubitril antagonises the AT1 receptor

    Valsartan blocks AT1 receptors; sacubitril inhibits neprilysin.

  • D. The combination causes irreversible beta blockade

    Neither drug is a beta blocker.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Combined neprilysin and ACE inhibition can greatly increase angioedema risk. Neprilysin inhibition also increases vasoactive peptides, including bradykinin.

Why is "Valsartan prevents renal elimination of ACE inhibitors" not the answer?

The concern is peptide metabolism, not renal drug elimination.

Why is "Sacubitril antagonises the AT1 receptor" not the answer?

Valsartan blocks AT1 receptors; sacubitril inhibits neprilysin.

Why is "The combination causes irreversible beta blockade" not the answer?

Neither drug is a beta blocker.

What concept does this question test?

It tests Heart failure: sacubitril-valsartan in Pharmacology. Combining it with an ACE inhibitor can cause excessive bradykinin accumulation, so a washout period is required.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Heart failure: sacubitril-valsartan?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.