Cardiovascular drugs: ivabradine: 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 · Cardiovascular drugs: ivabradine

Sample item

A 62-year-old man with heart failure and an ejection fraction of 30% is in sinus rhythm at 82 per minute despite maximally tolerated bisoprolol, an ACE inhibitor and spironolactone. Which add-on drug and characteristic effect are correct?

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

The answer and the reasoning

B. Ivabradine, which can cause luminous visual phenomena

Ivabradine selectively blocks the If (HCN) pacemaker current in the sinoatrial node, lowering heart rate without negative inotropy. It is added in sinus rhythm with a resting rate of 70 per minute or more despite optimal therapy. Phosphenes from retinal Ih channel blockade are a typical effect, and it is ineffective in atrial fibrillation.

Option by option

  • A. Flecainide, which can cause lupus-like illness

    Flecainide is contraindicated in structural heart disease, and lupus-like illness is not its characteristic effect.

  • B. Ivabradine, which can cause luminous visual phenomena (correct)

    Correct. Selective If blockade slows the sinus rate and lessens admissions for heart failure.

  • C. Amlodipine, which can cause ankle oedema

    Amlodipine is neutral in heart failure and does not reduce the rate.

  • D. Verapamil, which can cause constipation

    Verapamil is negatively inotropic and harmful in heart failure with reduced ejection fraction.

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, Ivabradine, which can cause luminous visual phenomena. Ivabradine selectively blocks the If (HCN) pacemaker current in the sinoatrial node, lowering heart rate without negative inotropy.

Why is "Flecainide, which can cause lupus-like illness" not the answer?

Flecainide is contraindicated in structural heart disease, and lupus-like illness is not its characteristic effect.

Why is "Amlodipine, which can cause ankle oedema" not the answer?

Amlodipine is neutral in heart failure and does not reduce the rate.

Why is "Verapamil, which can cause constipation" not the answer?

Verapamil is negatively inotropic and harmful in heart failure with reduced ejection fraction.

What concept does this question test?

It tests Cardiovascular drugs: ivabradine in Pharmacology. It is added in sinus rhythm with a resting rate of 70 per minute or more despite optimal therapy. Phosphenes from retinal Ih channel blockade are a typical effect, and it is ineffective in atrial fibrillation.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Cardiovascular drugs: ivabradine?

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.