WBR0735: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{YD}} (Reviewed by {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pharmacology, Physiology
|MainCategory=Pharmacology, Physiology
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|MainCategory=Pharmacology, Physiology
|MainCategory=Pharmacology, Physiology
|SubCategory=Vascular
|SubCategory=Vascular
|MainCategory=Pharmacology, Physiology
|MainCategory=Pharmacology, Physiology
|MainCategory=Pharmacology, Physiology
|MainCategory=Pharmacology, Physiology
|MainCategory=Pharmacology, Physiology
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|MainCategory=Pharmacology, Physiology
|MainCategory=Pharmacology, Physiology
|SubCategory=Vascular
|SubCategory=Vascular
|Prompt=A 52 year old male patient presents to the physician's office complaining of headache and blurry vision. His past medical history is only significant for dyslipidemia. He states that his blood pressure has been elevated on several previous occasions; but he has not been receiving any anti-hypertensive medication. His vital signs show a temperature of 36.8 degrees C (98.24 degrees F), a heart rate of 72 bpm, and a blood pressure measuring 158/92 mmHg. The physician decides to start the patient on a medication that also inhibits the breakdown of bradykinin. Based on the diagram below, at which level of the renin-angiotensin pathway does the prescribed medication act?
|Prompt=A 52-year-old man presents to the physician's office complaining of headache and blurry vision. His past medical history is only significant for dyslipidemia. He states that he often uses an electronic sphygmomanometer while resting at home. His blood pressure was elevated on several previous occasions in the past, but he has not been receiving any anti-hypertensive medication. In the clinic, his blood pressure is 158/92 mmHg, heart rate is 72/min, and temperature is 36.8 °C (98.24 °F). The physician decides to start the patient on a medication that also inhibits the breakdown of bradykinin. Based on the diagram below, at which level of the renin-angiotensin pathway does the prescribed medication act?


[[Image:WBR RAAS pathway.png|500px]]
[[Image:WBR RAAS pathway.png|500px]]
|Explanation=The prescribed medication to treat the patient's hypertension is most likely an angiotensin-converting enzyme (ACE) inhibitor. It is indicated for the management of hypertension and has compelling indications in specific cases such as the diabetic nephropathy due to its role in reducing proteinuria, which might by itself be injurious to the kidneys, and in left ventricular hypertrophy due to its role in preventing ventricular remodeling.  
|Explanation=The prescribed medication to treat the patient's hypertension is most likely an angiotensin-converting enzyme (ACE) inhibitor. It is indicated as first line agent for the management of hypertension, and has compelling indications in specific cases such as diabetic nephropathy and left ventricular hypertrophy. Classical adverse effects of ACE-I are angioedema, cough, and hyperkalemia. Cough is caused by the action of ACE-I that inhibits bradykinin breakdown, resulting in the accumulation of bradykinin with activation of inflammatory peptides and release of histamine.
 
Classical side effects of ACE-I are angioedema, cough, and hyperkalemia. Cough is caused by the action of ACE-I in inhibiting bradykinin breakdown, leading to its local accumulation with activation of inflammatory peptides and release of histamine.


Educational Objective: A classical side effect of ACE-I is dry cough. ACE-inhibitors act by preventing the production of


Reference: Karlberg BE. Cough and inhibition of the renin-angiotensin system. J Hypertens Suppl. 1993; 11(3):S49-S52.
|AnswerA=A
|AnswerA=A
|AnswerAExp=Renin is the enzyme that converts angiotensinogen to angiotensin I. Renin inhibitors act at this level.
|AnswerAExp=Renin is the enzyme that converts angiotensinogen to angiotensin I. Renin inhibitors act at this level.
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|AnswerBExp=ACE is the enzyme that converts angiotensin I to angiotensin II. ACE-inhibitors act at this level.
|AnswerBExp=ACE is the enzyme that converts angiotensin I to angiotensin II. ACE-inhibitors act at this level.
|AnswerC=C
|AnswerC=C
|AnswerCExp=ACE-I does not act at the level of the AT I receptor.
|AnswerCExp=ACE-I does not act at the level of the AT-I receptor.
|AnswerD=D
|AnswerD=D
|AnswerDExp=Angiotensin II receptor blockers (ARB) act at this level of the pathway.
|AnswerDExp=Angiotensin II receptor blockers (ARB) act at this level of the pathway.
|AnswerE=E
|AnswerE=E
|AnswerEExp=ACE-I does not act at this level of the pathway.
|AnswerEExp=ACE-I does not act at this level of the pathway.
|EducationalObjectives=A classical adverse effect of ACE-I is dry cough. ACE-inhibitors act by inhibiting the breakdown of bradykinin, resulting in the accumulation of bradykinin with activation of inflammatory peptides and release of histamine.
|References=Karlberg BE. Cough and inhibition of the renin-angiotensin system. J Hypertens Suppl. 1993;11(3):S49-S52.
|RightAnswer=B
|RightAnswer=B
|WBRKeyword=angiotensin, angiotensinogen, receptor, blocker, converting, enzyme, ACE, inhibitor, ACE inhibitor, cough, bradykinin, side, effect
|WBRKeyword=Angiotensin, Angiotensinogen, Receptor, Blocker, Converting, Adverse effect, Adverse, Enzyme, ACE, Inhibitor, ACE inhibitor, Cough, Bradykinin, Side, effect
|Approved=No
|Approved=Yes
}}
}}

Revision as of 19:27, 16 September 2014
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology, MainCategory::Physiology
Sub Category SubCategory::Vascular
Prompt [[Prompt::A 52-year-old man presents to the physician's office complaining of headache and blurry vision. His past medical history is only significant for dyslipidemia. He states that he often uses an electronic sphygmomanometer while resting at home. His blood pressure was elevated on several previous occasions in the past, but he has not been receiving any anti-hypertensive medication. In the clinic, his blood pressure is 158/92 mmHg, heart rate is 72/min, and temperature is 36.8 °C (98.24 °F). The physician decides to start the patient on a medication that also inhibits the breakdown of bradykinin. Based on the diagram below, at which level of the renin-angiotensin pathway does the prescribed medication act?

]]

Answer A AnswerA::A
Answer A Explanation AnswerAExp::Renin is the enzyme that converts angiotensinogen to angiotensin I. Renin inhibitors act at this level.
Answer B AnswerB::B
Answer B Explanation AnswerBExp::ACE is the enzyme that converts angiotensin I to angiotensin II. ACE-inhibitors act at this level.
Answer C AnswerC::C
Answer C Explanation AnswerCExp::ACE-I does not act at the level of the AT-I receptor.
Answer D AnswerD::D
Answer D Explanation AnswerDExp::Angiotensin II receptor blockers (ARB) act at this level of the pathway.
Answer E AnswerE::E
Answer E Explanation AnswerEExp::ACE-I does not act at this level of the pathway.
Right Answer RightAnswer::B
Explanation [[Explanation::The prescribed medication to treat the patient's hypertension is most likely an angiotensin-converting enzyme (ACE) inhibitor. It is indicated as first line agent for the management of hypertension, and has compelling indications in specific cases such as diabetic nephropathy and left ventricular hypertrophy. Classical adverse effects of ACE-I are angioedema, cough, and hyperkalemia. Cough is caused by the action of ACE-I that inhibits bradykinin breakdown, resulting in the accumulation of bradykinin with activation of inflammatory peptides and release of histamine.

Educational Objective: A classical adverse effect of ACE-I is dry cough. ACE-inhibitors act by inhibiting the breakdown of bradykinin, resulting in the accumulation of bradykinin with activation of inflammatory peptides and release of histamine.
References: Karlberg BE. Cough and inhibition of the renin-angiotensin system. J Hypertens Suppl. 1993;11(3):S49-S52.]]

Approved Approved::Yes
Keyword WBRKeyword::Angiotensin, WBRKeyword::Angiotensinogen, WBRKeyword::Receptor, WBRKeyword::Blocker, WBRKeyword::Converting, WBRKeyword::Adverse effect, WBRKeyword::Adverse, WBRKeyword::Enzyme, WBRKeyword::ACE, WBRKeyword::Inhibitor, WBRKeyword::ACE inhibitor, WBRKeyword::Cough, WBRKeyword::Bradykinin, WBRKeyword::Side, WBRKeyword::effect
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