Cardiovascular drugs: SGLT2 inhibitors in heart failure: 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: SGLT2 inhibitors in heart failure

Sample item

A non-diabetic man with symptomatic heart failure and an ejection fraction of 30 percent remains breathless despite an ACE inhibitor, a beta-blocker and spironolactone. Which glucose-lowering drug class has been shown to reduce heart failure hospitalisation in such patients?

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

The answer and the reasoning

A. SGLT2 inhibitors

Dapagliflozin and empagliflozin lower heart failure hospitalisation and cardiovascular death in HFrEF whether or not diabetes is present. The benefit is not simply from glucose lowering. Thiazolidinediones cause fluid retention and are contraindicated in heart failure.

Option by option

  • A. SGLT2 inhibitors (correct)

    Correct. SGLT2 inhibitors improve outcomes in HFrEF regardless of diabetes.

  • B. Thiazolidinediones

    Thiazolidinediones cause fluid retention and can worsen heart failure.

  • C. DPP-4 inhibitors

    DPP-4 inhibitors have no benefit in heart failure, and saxagliptin raised hospitalisation for it.

  • D. Sulfonylureas

    Sulfonylureas have no heart failure benefit and add hypoglycaemia risk.

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 A, SGLT2 inhibitors. Dapagliflozin and empagliflozin lower heart failure hospitalisation and cardiovascular death in HFrEF whether or not diabetes is present.

Why is "Thiazolidinediones" not the answer?

Thiazolidinediones cause fluid retention and can worsen heart failure.

Why is "DPP-4 inhibitors" not the answer?

DPP-4 inhibitors have no benefit in heart failure, and saxagliptin raised hospitalisation for it.

Why is "Sulfonylureas" not the answer?

Sulfonylureas have no heart failure benefit and add hypoglycaemia risk.

What concept does this question test?

It tests Cardiovascular drugs: SGLT2 inhibitors in heart failure in Pharmacology. The benefit is not simply from glucose lowering. Thiazolidinediones cause fluid retention and are contraindicated in heart failure.

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: SGLT2 inhibitors in heart failure?

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.