Heart failure 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 · Heart failure drugs: ivabradine

Sample item

A 58-year-old man with HFrEF (ejection fraction 30 percent) in sinus rhythm has a resting heart rate of 82 per minute despite maximally tolerated beta-blocker, ACE inhibitor and spironolactone. A drug that blocks the If current in the sinus node is added. Which adverse effect is characteristic?

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

The answer and the reasoning

B. Transient luminous visual phenomena (phosphenes)

Ivabradine slows the sinus node by inhibiting the hyperpolarisation-activated If current and reduces hospitalisation in HFrEF with sinus rhythm and a heart rate of 70 per minute or more on optimal therapy. Because related channels exist in the retina, patients may notice transient enhanced brightness or phosphenes. Bradycardia and atrial fibrillation are other effects.

Option by option

  • A. Hypokalaemia

    Hypokalaemia is a feature of loop and thiazide diuretics, not ivabradine.

  • B. Transient luminous visual phenomena (phosphenes) (correct)

    Correct. Retinal If-like current blockade causes phosphenes.

  • C. Dry persistent cough

    Dry cough is the typical effect of ACE inhibitors, which he already takes.

  • D. Gynaecomastia

    Gynaecomastia is a feature of spironolactone through antiandrogen action.

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, Transient luminous visual phenomena (phosphenes). Ivabradine slows the sinus node by inhibiting the hyperpolarisation-activated If current and reduces hospitalisation in HFrEF with sinus rhythm and a heart rate of 70 per minute or more on optimal therapy.

Why is "Hypokalaemia" not the answer?

Hypokalaemia is a feature of loop and thiazide diuretics, not ivabradine.

Why is "Dry persistent cough" not the answer?

Dry cough is the typical effect of ACE inhibitors, which he already takes.

Why is "Gynaecomastia" not the answer?

Gynaecomastia is a feature of spironolactone through antiandrogen action.

What concept does this question test?

It tests Heart failure drugs: ivabradine in Pharmacology. Because related channels exist in the retina, patients may notice transient enhanced brightness or phosphenes. Bradycardia and atrial fibrillation are other effects.

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 Heart failure 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.