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Old 02-25-2011
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Drug Adding a third antihypertensive drug to Rx

A 60-year-old Caucasian male with hypertension treated with maximum doses of hydrochlorothiazide and ramipril presents to your office with a persistently elevated blood pressure of approximately 160/100 mmHg and a heart rate of 56 beats/mm. You consider adding a third antihypertensive drug to his treatment regimen. But you are concerned about his prolonged AV conduction time (PR interval of 0.24 sec) on ERG. Which of the following drugs is most appropriate in this patient?


A. Verapamil
B. Metoprolol
C. Diltiazem
D. Nifedipine
E. Bepridil
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Old 02-25-2011
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D.nifedipine
Verapamil,metoprolol and diltiazem can cause Heart block.
Bepridil, a nonspecific calcium blocker that is infrequently used in the United States.
Nifedipine would be best answer.
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Old 02-25-2011
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Default D.

I agree with Taiyaki-kun: Nifedipine, as a dihydropyridine ccb, has little effect on cardiac tissue compared to non-dhp ccb's like verapamil or diltiazem, and metoprolol would slow his AV node conduction velocity.
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Old 02-25-2011
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A. Verapamil - Cardioselective Ca-channel blocker.
B. Metoprolol - B1 selective Cardiac blocker.
C. Diltiazem - Lesser Cardioselective than Verapamil but second line of drug for Ca channel blocker in both Cardiac and Vascular actions.
D. Nifedipine - Selective Vascular Ca-channel blocker.
E. Bepridil - ACEi just like the one being given with some effects on Heart.
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Old 02-25-2011
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also nifedipine has reflex tachycardia
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Old 02-26-2011
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D it is!
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Old 02-26-2011
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Quote:
Originally Posted by pakbrain View Post
also nifedipine has reflex tachycardia
Beneficial because current HR is 56, I guess it would balance?

Yes, answer is definitely Nifidepine.
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Old 02-26-2011
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Arrow D) Nifedipine

You guys are SUPPERS MART

Correct ans is D) Nifedipine


The treatment of hypertension is one of the most common reasons for physician office visits and use of prescription drugs in the United States. There are approximately 58 to 65 million hypertensive patients in the adult population in the United States. The number of patients with hypertension is likely to grow as the population ages, as both pure systolic hypertension and combined systolic/diastolic hypertension occur in over one-half of all people over age 65.

Therapy for hypertension can often be difficult with many patients requiring 2 or more antihypertensive medications. The rigorous treatment of hypertension is important as it is the most common risk factor for heart disease, ahead of diabetes, smoking dyslipidemia, and male gender or postmenopausal state.
Normal blood pressure (BP) is defined as systolic BP <120 mmHg and diastolic BP <80. Prehypertension is defined as a systolic BP of 120-139 or a diastolic BP of 80-89, and hypertension is defined as a systolic BP of 140 or greater or a diastolic BP of 90 or greater.

Nifedipine is the correct choice in this case as it is effective as an anti hypertensive agent and has a minimal effect on AV conduction unlike each of the other drugs listed.
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