WBR244
| Author | PageAuthor::Gerald Chi |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pharmacology |
| Sub Category | SubCategory::Cardiology |
| Prompt | [[Prompt::A 57-year-old female comes to the clinic because of tingling sensations of her digits. She states that her fingers turn blue on exposure to cold water and about 10 minutes later, the fingers appear pale and eventually become red and swollen. She also reports mild malaise but there is no morning stiffness, joint pain or deformity, or edema of legs. She is taking esmolol for congestive heart failure. If pharmacotherapy is indicated, which of the following drugs would be the most appropriate to control her symptoms?]] |
| Answer A | AnswerA::Add felodipine |
| Answer A Explanation | [[AnswerAExp::Correct Felodipine is a dihydropyridine calcium channel blocker that may be used in treating Raynaud phenomenon.]] |
| Answer B | AnswerB::Add nimodipine |
| Answer B Explanation | [[AnswerBExp::Incorrect Felodipine works preferentially on cerebral vasculature. It is used to control cerebral vasospasm in conditions of subarachnoid hemorrhage.]] |
| Answer C | AnswerC::Add diltiazem |
| Answer C Explanation | [[AnswerCExp::Incorrect Adding diltiazem on top of esmolol is inappropriate since excessive nodal suppression may be a concern.]] |
| Answer D | AnswerD::Add verapamil |
| Answer D Explanation | [[AnswerDExp::Incorrect Adding verapamil on top of esmolol is inappropriate since excessive nodal suppression may be a concern. Verapamil is not as effective as dihydropyridines in treating Raynaud phenomenon.]] |
| Answer E | AnswerE::Replace metoprolol with labetalol |
| Answer E Explanation | [[AnswerEExp::Incorrect Labetalol is a mixed alpha/beta antagonist and is generally not considered in patients with congestive heart failure. It is not shown to have effects on treating Raynaud phenomenon.]] |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::Triphasic discoloration of digits on exposure to cold environment is a typical presentation for Raynaud phenomenon. Among the drug classes that have been used are calcium channel blockers, vasodilators, sympatholytic agents, and prostaglandins Educational Objective: |
| Approved | Approved::No |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |