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Drug of choice for Hypertension in an asthmatic, hyperkalemic, renal impaired patient!

15K views 15 replies 13 participants last post by  salz 
#1 ·
A 56 year old African American female with a history of asthma is diagnosed with hypertension. Laboratory studies reveal a creatinine of 3.0 mg/dL and a potassium level of 5.1 mg/dL. Which of the following medications is appropriate to treat her hypertension?

A) amlodipine
B) hydrochlorothiazide
C) enalapril
D) propranolol
E) spironolactone
 
#3 ·
I think answer is Amlodipine, because you can´t give her enalapril and spironolactona, because you´ll worsen the hyperkalemia. And propanolol is contraindicated because of her antecedent of asthma.
And hidroclorothiazide is contraindicated because of her renal injury.

And besides the above, the recomendation in black people is a calcium channel bloker like amlodipine
 
#11 · (Edited)
Correct answer

Answer: A - amlodipine

Selecting the appropriate antihypertensive regimen requires knowledge of side-effects and contraindications to each drug class. Dihyropyridine calcium channel blockers anything that ends in "dipine" such as amlodipine or nifedipine) work to block vascular calcium channels resulting in vascular smooth muscle relaxation and have no specific contraindications. They can cause peripheral edema (due to venous dilation) and dizziness. Non-dihydropyridine calcium channel blockers (verapamil and diltiazem) work mostly on cardiac calcium channels and thus decrease the heart rate and inotropy of the heart. They can also be used to treat hypertension and are contraindicated in systolic congestive heart failure.*
Hydrochlorothiazide (B) is not effective to treat hypertension when renal insufficiency is present. Enalapril (C), an ACE inhibitor, is contraindicated in chronic kidney disease with a creatinine greater than 2.5 mg/dL or a potassium greater than 5.5 mg/dL. Propranolol (D) is a non-cardioselective beta-blocker (blocks both beta-1 and beta-2 receptors) which can worsen asthmatic bronchoconstriction (cardioselective beta-blockers do this to a lesser degree). Spironolactone (E), an aldosterone antagonist, is also contraindicated in renal insufficiency and with elevated potassium levels.
 
#14 ·
Answer: A - amlodipine

Selecting the appropriate antihypertensive regimen requires knowledge of side-effects and contraindications to each drug class. Dihyropyridine calcium channel blockers anything that ends in “dipine” such as amlodipine or nifedipine) work to block vascular calcium channels resulting in vascular smooth muscle relaxation and have no specific contraindications. They can cause peripheral edema (due to venous dilation) and dizziness. Non-dihydropyridine calcium channel blockers (verapamil and diltiazem) work mostly on cardiac calcium channels and thus decrease the heart rate and inotropy of the heart. They can also be used to treat hypertension and are contraindicated in systolic congestive heart failure.*
Hydrochlorothiazide (B) is not effective to treat hypertension when renal insufficiency is present. Enalapril (C), an ACE inhibitor, is contraindicated in chronic kidney disease with a creatinine greater than 2.5 mg/dL or a potassium greater than 5.5 mg/dL. Propranolol (D) is a non-cardioselective beta-blocker (blocks both beta-1 and beta-2 receptors) which can worsen asthmatic bronchoconstriction (cardioselective beta-blockers do this to a lesser degree). Spironolactone (E), an aldosterone antagonist, is also contraindicated in renal insufficiency and with elevated potassium levels.
 
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