doc4mindia
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One week after beginning treatment with captopril 12.5 mg three times/day for hypertension, an 85-year-old woman reports decreased appetite because of a bad taste in her mouth. She has severe constipation. She has a pulse of 57/minute and a blood pressure of 170/95 mm Hg while supine and 150/90 mm Hg while standing. Renal function studies disclose no abnormalities. At her initial visit two months ago, her blood pressure was 180/95 mm Hg. Since that time, therapy with hydrochlorothiazide, clonidine, and nifedipine has been tried and discontinued because of adverse effects.
The most appropriate next step is to:
a. continue captopril at the same dosage
b. discontinue captopril
C. switch to hydrochlorothiazide
d. switch to verapamil
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| meg
Forum Guru
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a
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| doc4mindia
Forum Guru
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The answer Is B
The most appropriate next step in the management of this patient is immediate discontinuation of captopril, followed by nonpharmacologic intervention, such as diet, exercise, and weight loss. Constipation is an adverse effect of captopril therapy.
In a patient with no evidence of renal artery stenosis or end-organ damage, quality of life is the most important consideration; any further drug treatment should be carefully considered.
Pharmacologic therapy is now widely recommended for hypertension, regardless of patient age. The SHEP study has shown significant reductions in stroke and stroke mortality following stepwise treatment of systolic hypertension in elderly adults. ~-Adrenergic blockers or verapamil should not be used because of sinus bradycardia.
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| nidhik15
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non pharmacologis remedies are tried before initiating drug so i presume he is has failre of the non pharma appraoch before e was put on drugs. Chronic cough is the only indication to sptop captopril...i wold say continue the drug ie a
i shall look up the text too. corrext me
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