Drug of choice for Hypertension in an asthmatic, hyperkalemic, renal impaired patient! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 09-10-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 51
Threads: 7
Thanked 79 Times in 32 Posts
Reputation: 89
Drug Drug of choice for Hypertension in an asthmatic, hyperkalemic, renal impaired patient!

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
Reply With Quote Quick reply to this message
The above post was thanked by:
Abdulaziz (09-10-2011), drnrpatel (09-10-2011), usluipek (09-10-2011)



  #2  
Old 09-10-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS+3
Posts: 93
Threads: 21
Thanked 37 Times in 16 Posts
Reputation: 47
Default

i say B to treat both HTN n renal failure, plus they favor thiazides for African Americans
Reply With Quote Quick reply to this message
  #3  
Old 09-10-2011
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 7
Threads: 4
Thanked 18 Times in 5 Posts
Reputation: 28
Default

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
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (09-10-2011), Bibi (09-10-2011)
 
  #4  
Old 09-10-2011
akua's Avatar
USMLE Forums Addict
 
Steps History: Not yet
Posts: 167
Threads: 0
Thanked 31 Times in 31 Posts
Reputation: 41
Default

B.hydrochlorothiazide
Reply With Quote Quick reply to this message
  #5  
Old 09-10-2011
USMLE Forums Scout
 
Steps History: 1 + CK
Posts: 44
Threads: 2
Thanked 35 Times in 13 Posts
Reputation: 45
Default

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
Reply With Quote Quick reply to this message
  #6  
Old 09-10-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 39
Threads: 6
Thanked 35 Times in 11 Posts
Reputation: 45
Default

A) Amlodipine
Reply With Quote Quick reply to this message
  #7  
Old 09-10-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 10
Threads: 1
Thanked 2 Times in 2 Posts
Reputation: 12
Default

hydrochlorothiazide B
Reply With Quote Quick reply to this message
  #8  
Old 09-10-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS+3
Posts: 93
Threads: 21
Thanked 37 Times in 16 Posts
Reputation: 47
Default

Can someone give the right answer....
Reply With Quote Quick reply to this message
  #9  
Old 09-10-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 512
Threads: 57
Thanked 319 Times in 163 Posts
Reputation: 329
Default

Amlodipine is fine to use
Reply With Quote Quick reply to this message
  #10  
Old 09-10-2011
Claus_CU's Avatar
USMLE Forums Addict
 
Steps History: 1 + CS
Posts: 113
Threads: 8
Thanked 89 Times in 61 Posts
Reputation: 99
Default

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)
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (09-10-2011)
  #11  
Old 09-10-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 51
Threads: 7
Thanked 79 Times in 32 Posts
Reputation: 89
Correct Answer 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.

Last edited by alaahoda2001; 09-10-2011 at 11:45 PM. Reason: Typo
Reply With Quote Quick reply to this message
The above post was thanked by:
Abdulaziz (09-14-2011), aknz (09-11-2011), Dr.Frz (08-06-2013), rayattt (09-13-2011), ricko335 (09-24-2011), zohra (09-11-2011)
  #12  
Old 09-10-2011
USMLE Forums Newbie
 
Steps History: CK Only
Posts: 1
Threads: 0
Thanked 0 Times in 0 Posts
Default

amlodipine is one of the Dihydropyridine calcium channel blockers while diltiazim and verapamil are non-Dihydropyridine calcium channel blockers
Reply With Quote Quick reply to this message
  #13  
Old 09-10-2011
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 51
Threads: 7
Thanked 79 Times in 32 Posts
Reputation: 89
Default

Quote:
Originally Posted by ibtisam View Post
amlodipine is one of the Dihydropyridine calcium channel blockers while diltiazim and verapamil are non-Dihydropyridine calcium channel blockers
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
Reply With Quote Quick reply to this message
  #14  
Old 09-24-2011
USMLE Forums Scout
 
Steps History: ---
Posts: 29
Threads: 12
Thanked 10 Times in 4 Posts
Reputation: 20
Default

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.
Reply With Quote Quick reply to this message
The above post was thanked by:
docnok (09-24-2011), MANIAKOS (09-24-2011), ricko335 (09-24-2011), usluipek (09-25-2011)
  #15  
Old 09-24-2011
USMLE Forums Addict
 
Steps History: Not yet
Posts: 191
Threads: 8
Thanked 121 Times in 76 Posts
Reputation: 131
Default

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.
Reply With Quote Quick reply to this message
The above post was thanked by:
docnok (09-24-2011)



  #16  
Old 09-24-2011
USMLE Forums Guru
 
Steps History: Not yet
Posts: 417
Threads: 74
Thanked 131 Times in 94 Posts
Reputation: 141
Default

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.
Reply With Quote Quick reply to this message



Reply

Tags
Pharmacology-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Drug of Choice for Tinea Capitis? USDreamer USMLE Step 2 CK Forum 4 06-19-2012 05:31 AM
Drug of choice for this? sam01 USMLE Step 1 Forum 10 08-17-2010 02:53 AM
The Drug of Choice for CMV Infection Yallah USMLE Step 1 Forum 6 06-19-2010 05:45 PM
The drug of choice for this patient? FreakingOut USMLE Step 1 Forum 2 05-17-2010 11:19 AM
Drug of Choice for Epilepsy During Pregnancy? obgynaim USMLE Step 2 CK Forum 2 03-22-2010 07:10 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)