We have Set Up all the PEP exam Assistance You Need?
Great topic! This is a guaranteed section in the PEP. You don’t need to memorize the entire JNC-8 or ADA guidelines, but you MUST know the “Compelling Indications”—the specific scenarios where one drug class is mandatory unless contraindicated.
Here is the “Drug of Choice” (DOC) cheatsheet I give my interns for the CBT. Memorize this table!
In the exam, look for the patient’s profile first. Don’t just pick “Lisinopril” because it’s popular.
Critical Exam Warning: NEVER combine an ACEI (e.g., Lisinopril) with an ARB (e.g., Losartan). It causes hyperkalemia and renal damage without added benefit.
For DM questions, the answer depends on the patient’s kidney and heart status.
Absolute First-Line (All Patients): Metformin.
Unless contraindicated: eGFR < 30 mL/min (Kidney failure) or acute Heart Failure.
If Patient has CVD (Heart Disease) or Kidney Disease:
Add an SGLT2 Inhibitor (e.g., Empagliflozin) or GLP-1 Agonist (e.g., Liraglutide). These have proven cardiovascular benefits.
Gestational Diabetes (Pregnancy):
Insulin is the gold standard.
Exam Trick: Metformin and Glyburide are sometimes used, but if the option “Insulin” is there, pick Insulin for PEP exams.
(Try these without looking up the answers!)
Q: A 55-year-old Black man has Hypertension and Type 2 Diabetes with proteinuria. What is the best initial drug?
A: ACEI or ARB. (Even though he is Black, the CKD/Proteinuria trumps the race rule. You must protect the kidneys).
Q: Which antihypertensive can mask the warning signs of hypoglycemia (palpitations/tremors) in a diabetic patient?
A: Beta-Blockers (Non-selective ones like Propranolol).
Q: Which antidiabetic drug is contraindicated in Heart Failure Class III/IV?
A: Thiazolidinediones (Pioglitazone/Rosiglitazone) because they cause fluid retention.
