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Old 08-19-2011
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Drug Drug Contraindicated in Hypertension

A 56-yr-old woman arrives in the emergency department complaining of dizziness and headache. Her blood pressure is 210/140 mmHg. She is currently not taking any medications and has not seen a doctor for several years. The physician decides to address her hypertension urgently. Which of the following drugs is contraindicated in this patient?

a. IV diltiazem
b. IV labetalol
c. IV metoprolol
d. Oral captopril
e. Sublingual nifedipine

Last edited by ujustgotdoctored; 08-19-2011 at 06:56 AM.
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b. IV labetalol
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if this is malignant HT due to renal artery stenosis, it could be Captopril, since they are C/I in Renal A. Stenosis.
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Default ?sublingual nifedipine

E sublingual nifedipine?
pls what is the answer?
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I think renal artery stenosis is an important cause of mailignant Hypertension and captopril is contraindicated in that so D
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Quote:
Originally Posted by nativedoc2 View Post
E sublingual nifedipine?
pls what is the answer?
Nifedipine will cause reflex tachycardia so it can be too contraindicated but I think captopril is the best choice

Last edited by usmle2011; 08-19-2011 at 10:46 AM.
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Quote:
Originally Posted by patelMD View Post
if this is malignant HT due to renal artery stenosis, it could be Captopril, since they are C/I in Renal A. Stenosis.
how do u say its Renal Artery Stenosis?
is der any clue in the stem.
y cudnt be malignant HT.
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Default malignant hypertension or severe hypertension?

i dont really remember but i think malignant HTN is a rapidly developing HTN that proceeds to fibrinoid necrosis in the kidneys, we were not given any indication that she has that.

i was thinking that this is a case of severe HTN, they specifically mention dizziness and headache, nifedine is notorious for causing headaches, thats why i choose nifedipine.

i really dont know, and i am shamed to say i dont even think my answer makes much sense.

can the poster pls post the correct answer with the explanation

thanks

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Originally Posted by usmle2011 View Post
Nifedipine will cause reflex tachycardia so it can be too contraindicated but I think captopril is the best choice
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i guess its sublingual nifedipine
In patients with malignanthypertension without encephalopathy or another catastrophic event, it is preferable to reduce blood pressure over hours or longer rather than minutes. This goal may effectively be achieved initially with frequent dosing of short-acting oral agents such as captopril, clonidine, and labetalol.
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Quote:
Originally Posted by ricko335 View Post
i guess its sublingual nifedipine
In patients with malignanthypertension without encephalopathy or another catastrophic event, it is preferable to reduce blood pressure over hours or longer rather than minutes. This goal may effectively be achieved initially with frequent dosing of short-acting oral agents such as captopril, clonidine, and labetalol.
If a patient has malignant hypertension and you give them an ACE-I, you will destroy their kidneys.
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Default Answer is E. sublingual Nifedipine

nifedipine is a peripheral Ca blocker. It can be used in long term tx for HTN, but for an emergency it is contraindicated because it can cause reflex tachycardia which can worsen HTN symptoms. All of the other drugs can be used in this situation.
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Quote:
Originally Posted by patelMD View Post
if this is malignant HT due to renal artery stenosis, it could be Captopril, since they are C/I in Renal A. Stenosis.
First time i saw this question I thought they were angling towards that as well but the symptoms do not show anything about a renal artery stenosis
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Quote:
Originally Posted by nativedoc2 View Post
i dont really remember but i think malignant HTN is a rapidly developing HTN that proceeds to fibrinoid necrosis in the kidneys, we were not given any indication that she has that.

i was thinking that this is a case of severe HTN, they specifically mention dizziness and headache, nifedine is notorious for causing headaches, thats why i choose nifedipine.

i really dont know, and i am shamed to say i dont even think my answer makes much sense.

can the poster pls post the correct answer with the explanation

thanks
I give ppl 5-6 hrs to try to come up with their answer then i post the answer.
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Default thanks

thanks 4 the question, very helpful esp to someone like me who hasn't subscribed yet to any qbank.
i just get a little impatient to know the ans, pay me no mind on that!

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I give ppl 5-6 hrs to try to come up with their answer then i post the answer.
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Quote:
Originally Posted by ujustgotdoctored View Post
First time i saw this question I thought they were angling towards that as well but the symptoms do not show anything about a renal artery stenosis
The symptoms of essential hypertension are present with malignant hypertension, and also malignant hypertension is usually above >200/>100 so that's why I thought.

Let's see, I guess second option of nifedepine causing headache maybe the answer.
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Old 08-25-2011
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I agree nifedipine will cause reflex tachcardia.

But..

why does the captopril "free" of reflex tachycardia?

decrease preload via decreased aldosterone and ATII(in PCT) results in reflex tachcardia.
decrease vascular resistance(via decreased ATII) results also in reflex tachycardia.

Sorry, I'm confused.
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