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An 11-year-old boy with ADHD is started on amphetamine-dextroamphetamine XR after inadequate response to behavioral therapy alone. His past medical history is unremarkable, and family history is negative for congenital heart disease or sudden cardiac death. At baseline, his BP is 100/62 mmHg and HR is 84 bpm. The NP counsels his parents on adverse effects that require ongoing monitoring. Which cardiovascular risk is most important to assess during follow-up visits? 

A 59-year-old man presents for follow-up 3 weeks after hospital discharge for an acute anterior STEMI treated with PCI and stent placement. He is asymptomatic today but asks what medications he “really needs to stay on long term to prevent another heart attack.” His current prescriptions include aspirin, ticagrelor, atorvastatin 80 mg, metoprolol succinate, and lisinopril. Which combination of therapies has been shown to improve survival and reduce reinfarction risk in patients with prior MI? 

A 62-year-old man with type 2 diabetes and hypertension is on atorvastatin 80 mg daily. He has no history of ASCVD. Despite good adherence, his LDL-C remains 92 mg/dL. His 10-year ASCVD risk is 26%. He asks whether he should “just try a different cholesterol pill” since the statin hasn’t brought him below 70. Which is the most appropriate next pharmacologic step? 

A 60-year-old woman with diabetes and hyperlipidemia has been on rosuvastatin 40 mg for 8 months. She presents to clinic with severe muscle pain, weakness, and dark urine. Exam shows diffuse muscle tenderness. Which statin-associated adverse effect mandates immediate discontinuation of therapy? 

Which adverse effect is most concerning with benzodiazepines in older adults? 

Sudden withdrawal of beta blockers may precipitate: 

A patient with treatment-resistant schizophrenia is started on clozapine. What is the most important baseline test? 

A 64-year-old man with ischemic cardiomyopathy (LVEF 25%) presents with dyspnea on exertion and peripheral edema. He is initiated on lisinopril, carvedilol, and spironolactone, consistent with guideline-directed medical therapy for HFrEF. Which additional medication would be expected to improve symptoms of volume overload but is not associated with a reduction in mortality? 

A 72-year-old woman with hypertension and osteoarthritis is prescribed digoxin. Her renal function shows eGFR 28 mL/min. What adjustment is most critical? 

Which drug type requires especially close therapeutic monitoring?