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
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
I would go with Amlodipine too or a Ca ch blocker anyway in this case
beta blocker cant give to an asthamatic
enalapril and spironolactone both can worsen the hyperkalemia
Hcl thiazide wouldnt work that efficiently because of renal injury-cr of 3
A) amlodipine = YES
B) hydrochlorothiazide = NO (kidneys are not functioning)
C) enalapril = NO (creatinine of 3.0 mg/dL and a potassium level of 5.1 mg/dL)
D) propranolol = NO (asthma)
E) spironolactone = NO (potassium level of 5.1 mg/dL)
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.
Yes, you r right
Thank you veryuch for the notice
Actually there was a typo on the web site and I have nit noticed it when I copied and pasted the answer
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.
Answer is A. Amlodipine as calcium channel blockers are DOC in asthmatics.
Beta blocker can not be given because it can precipitate asthma,one of the side effect of ACE inhibitor is hyperkalemia hence in this pt its already suffering from hyperkalemia it can not be given.
exactly i agree with A.
i narrowed it down.
rule out spironlactone cuz it is K sparing and K is already high.
rule out propranolol cuz it will block B2 receptors.
rule out thiazide and ace inh cuz not safe for renal failure.
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