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Medication

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AAAAA
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02/28/07 - 03:28 PM

A 55-year-old man with coronary artery disease is evaluated 2 weeks after having had a myocardial infarction. On discharge, his medications included aspirin, sustained-release metoprolol, isosorbide mononitrate, lisinopril, and atorvastatin. Echocardiogram at that time showed inferior and posterior wall akinesis and a left ventricular ejection fraction of 40%.

On examination, his heart rate is 60/min and his blood pressure is 130/70 mm Hg. Jugular venous pressure is normal and the chest is clear. Cardiac rhythm is regular, with normal S1 and S2 and no murmurs or extra heart sounds. Laboratory results from yesterday are potassium 5.7 meq/L (5.7 mmol/L), creatinine 1.0 mg/dL (88.42 µmol/L), and LDL cholesterol 65 mg/dL (1.68 mmol/L). Lisinopril therapy is stopped.

Which of the following medications should be started in this patient?

A Valsartan

B Spironolactone

C Amlodipine

D Eplerenone

E Hydralazine

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idoc
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03/01/07 - 10:52 PM

amirhossein
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03/01/07 - 11:10 PM

B is the best choice.

eplerenone takes 4 weeks to come into effect.

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AAAAA
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03/02/07 - 11:22 AM

B Spironolactone will kill the patient, spirolactone causes hyperkalemia and patient is already having high potassium.

Spironolactactone is usually used in Stage 4 (class4) CHF.

Any other choices and why?

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AAAAA
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03/02/07 - 11:22 AM

K 5.7, B will causes K to go up and pt dies of arrthymia

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whiterabbit

03/02/07 - 12:08 PM

C Amlodipine

amirhossein
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03/02/07 - 12:28 PM

AAAAA wrote:
K 5.7, B will causes K to go up and pt dies of arrthymia

Yes, you are right. Spirinolactone, eplerenone and valsartan cause hyperkalemia. Hydralazine may cause severe hypotension in this post-MI patient. So I choose amlodipine. Amlodipine may again put the heart susceptible to arrhythmia, when K=5.7.

Anyway, this question doesn't seem correct to me, this patient doesn't need any medication at all. Just needs oservation and Follow up.

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whiterabbit

03/02/07 - 12:36 PM

Y will amlodipine => Arry

AAAAA
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03/02/07 - 03:02 PM

C is wrong

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whiterabbit

03/02/07 - 03:25 PM

#10

What is the answer

AAAAA
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03/03/07 - 07:10 AM

#11

E

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PGI2alpha
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03/30/07 - 10:56 AM

#12

can u pls explain why hydralazine and tht too in an out patient...

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