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  #1  
Old 06-13-2014
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Default Pharm Question

A 52 year old patient comes to your clinic with a complaint of headache and easy fatigability on moderate exertion. On physical examination his blood pressure is 155/90. While doing physical examination you note a perforated nasal septum and multiple needle scars over his arms. Echocardiography shows a moderately hypertrophic left ventricle. You make the diagnosis of hypertension with grade two CHF. Which of the following drugs can be used to treat his diseases and increase the patient's long term survival?

A. Hydrochlorothiazide
B. Verapamil
C. Propranolol
D. Spironolactone
E. Glycopyrrolate
F. Oxybutynin
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Old 06-13-2014
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Originally Posted by hemlock View Post
A 52 year old patient comes to your clinic with a complaint of headache and easy fatigability on moderate exertion. On physical examination his blood pressure is 155/90. While doing physical examination you note a perforated nasal septum and multiple needle scars over his arms. Echocardiography shows a moderately hypertrophic left ventricle. You make the diagnosis of hypertension with grade two CHF. Which of the following drugs can be used to treat his diseases and increase the patient's long term survival?

A. Hydrochlorothiazide
B. Verapamil
C. Propranolol
D. Spironolactone
E. Glycopyrrolate
F. Oxybutynin
Well i think its D.Spironolactone. Its the only drug on the list that proven to decrease mortality in heart patients.
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Old 06-13-2014
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i think its verapamil
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Old 06-13-2014
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I think hydrochlorothiazide.
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Old 06-13-2014
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Default Answer

Drugs which have been shown to decrease mortality in CHF patients are:
-Beta blockers
-ACEI
-Spironolactone

This question tells you that the patient has nasal septum perforation and needle marks, signs of Cocaine use. So among these drugs you can not use beta blockers because in people who use cocaine, it can lead to unrestrained alpha action and lead to malignant hypertension. The only other drug mentioned in the choice is spironolactone.

Although HCT is the first line drug in managing hypertension, it has not been shown to decrease mortality.
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Old 06-14-2014
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Quote:
Originally Posted by hemlock View Post
A 52 year old patient comes to your clinic with a complaint of headache and easy fatigability on moderate exertion. On physical examination his blood pressure is 155/90. While doing physical examination you note a perforated nasal septum and multiple needle scars over his arms. Echocardiography shows a moderately hypertrophic left ventricle. You make the diagnosis of hypertension with grade two CHF. Which of the following drugs can be used to treat his diseases and increase the patient's long term survival?

A. Hydrochlorothiazide
B. Verapamil
C. Propranolol
D. Spironolactone
E. Glycopyrrolate
F. Oxybutynin

actually its a very nice question. we know very well in CHF the drugs which reduce mortality is 1,beta blockers
2,ACE Inhibitors
3,diuretics

here v got to know that patient is a cocaine abuse because of nasal septum perforation,needle stick marks,underlying cardic pathology.beta blocker is contraindicated in cocaine toxicites because it causes unopposed alpha agonist actions and causes severe hypertension.

so the only remaining correct answer is thiazide diuretic- spirinolactone
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