WBR242

Author	[[PageAuthor::Gerald Chi (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pharmacology
Sub Category	SubCategory::Cardiology
Prompt	[[Prompt::A 58-year-old woman presents to her physician's office for a routine examination. Upon review of systems, the women states that she is asymptomatic and has no complaints. She reports that she was prescribed an antihypertensive drug by another primary care physician 6 months ago and has been taking one tablet each day. In the clinic, she is afebrile with a blood pressure of 130/80 mmHg, heart rate of 58/min, and respiratory rate of 14/min. Physical examination is unremarkable. Laboratory work-up demonstrates a total cholesterol concentration of 220 mg/dl, LDL-C of 100 mg/dl, HDL-C of 50 mg/dl, triglyceride concentration of 350 mg/dl. Upon further questioning, she states that she never had abnormal lipid profiles in the past. Which of the following antihypertensive drugs is the patient most likely receiving?]]
Answer A	AnswerA::Prazosin
Answer A Explanation	AnswerAExp::Prazosin is an alpha-1 adrenergic antagonist (alpha blocker). Prazosin is typically associated with orthostatic hypotension and nasal congestion.
Answer B	AnswerB::Lisinopril
Answer B Explanation	AnswerBExp::Lisinopril is an angiotensin-converting enzyme inhibitor (ACE-I). ACE-I are typically associated with cough and hyperkalemia.
Answer C	AnswerC::Clonidine
Answer C Explanation	AnswerCExp::Clonidine is a centrally acting alpha-2 agonist. Clonidine is typically associated with lightheadednes, dry mouth, dizziness, constipation, and hypotension.
Answer D	AnswerD::Atenolol
Answer D Explanation	AnswerDExp::Atenolol is a non-selective beta blocker. Beta blockers are typically associated with bradycardia and dyslipidemia.
Answer E	AnswerE::Verapamil
Answer E Explanation	AnswerEExp::Verapamil is a non-dihydropyridine calcium channel blocker (CCB). Non-dihydropyridine CCBs are typically associated with constipation and GI distress.
Right Answer	RightAnswer::D
Explanation	[[Explanation::The patient is most likely receiving a beta blocker. Beta-blockers are antihypertensive, sympatholytic agents that reduce the cardiac output by binding to beta-adrenoreceptors present in the cardiac nodal tissue, thereby decreasing the number of unoccupied receptors available for norepinephrine and epinephrine to bind to. Beta blockers bind to may be either cardioselective (B1 blockade > B2 blockade) or non-selective (both B1 and B2 blockade). Adverse effects associated with the undesired β2-adrenergic antagonism include bradycardia (heart rate < 60/min), bronchospasm, peripheral vasoconstriction, and alteration of glucose and lipid metabolism. These effects are typically observed with administration of non-selective beta blockers or at higher doses of cardioselective beta blockers. Educational Objective: Beta-blockers are antihypertensive, sympatholytic agents that reduce the cardiac output by binding to beta-adrenoreceptors present in the cardiac nodal tissue, thereby decreasing the number of unoccupied receptors available for norepinephrine and epinephrine to bind to. Adverse effects associated with the undesired β2-adrenergic antagonism include bradycardia (heart rate < 60/min), bronchospasm, peripheral vasoconstriction, and alteration of glucose and lipid metabolism. References: ]]
Approved	Approved::No
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