WBR0455

Author	PageAuthor::Neeraja Danda M.B.B.S
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Cardiovascular
Prompt	[[Prompt::A 46 year old male came to his physician’s office for an annual physical. His past medical history is significant for hypertension, congestive heart failure secondary to myocardial infarction and diabetes mellitus. His current medications are aspirin, atenolol, glibenclamide , spirinolactone, captopril and atorvastatin. Vitals are: pulse rate 82/min, blood pressure 130/80 mm Hg and respiratory rate 19/min. He eats vegetables and meat and walks for an hour, 3 times a week.On further questioning he expresses concern regarding the appearance of his breasts over the past several months. Inspection of the breasts shows the following findings. Citation::FatM1ke . Self image, www.Wikipedia.com 16 April 2008 Which of the following medication change is necessary in this patient?]]
Answer A	AnswerA::Atorvastatin to niacin
Answer A Explanation	AnswerAExp::'''Incorrect''' Atorvastatin is a lipid lowering drug with mortality benefits in myocardial infarction, it has no relation with gynecomastia.
Answer B	AnswerB::Spirinolactone to eplerenone
Answer B Explanation	AnswerBExp::Eplerenone can be substituted for spironolactone in these cases, as it does not have anti- androgenic side effects.
Answer C	AnswerC::Captopril to losartan
Answer C Explanation	AnswerCExp::'''Incorrect''' Captopril is an angiotensin converting enzyme inhibitor , it should be replaced with losartan ( angiotensin receptor blocker) only if the patient suffers cough as a side effect
Answer D	AnswerD::Glibenclamide to Insulin
Answer D Explanation	AnswerDExp::'''Incorrect''' Changing from glibenclamide to insulin is necessary only if the patient’s blood sugar levels are not controlled, there is no such indication in this question
Answer E	AnswerE::Spirinolactone to digoxin
Answer E Explanation	AnswerEExp::'''Incorrect''' Spirinolactone should be replaced, but not with digoxin
Right Answer	RightAnswer::B
Explanation	[[Explanation::The above image demonstrates male breast enlargement known as gynecomastia. Gynecomastia is a side effect of spirinolactone due to its anti androgenic effect. Sprinolactone can be replaced with eplerenone , which is also a potassium sparing diuretic. Eplerenone also confers a mortality benefit in heart failure but does not cause gynecomastia. Educational Objective: Gynecomastia is a side effect of spirinolactone use. Eplerenone can be substituted for spironolactone in these cases, as it does not have anti- androgenic side effects. References: Page 79, 80 Master the boards Step 2 CK second edition Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Heart failure, WBRKeyword::Spirinolactone, WBRKeyword::Eplerenone, WBRKeyword::Gynecomastia
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