A hypertensive crisis in a patient should be managed with the following medication:
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What to do when a patient blood pressure is high in emergency
Sri K.
A 58-year-old African American male presented to his primary care physician (PCP) for routine follow-up. Eighteen months earlier, the patient was diagnosed with essential hypertension as indicated by a blood pressure reading of 155/98 mm Hg. At that time, the PCP prescribed the angiotensin-converting enzyme inhibitor (ACEI) lisinopril (20 mg/day) for blood pressure control. In the routine follow-up appointment, the patient’s blood pressure was 128/80 mm Hg. Upon questioning, however, he reported a troublesome chronic cough. After eliminating allergies, infection, and cardiopulmonary conditions as underlying causes, the PCP attributed the cough to the ACEI and switched the patient’s antihypertensive medication to the angiotensin II receptor blocker (ARB) telmisartan (40 mg/day). In a 1-month follow-up appointment, the patient reported cessation of the cough, and his blood pressure was 126/78 mm Hg. What is the mechanism by which ACEI cause the cough? Select one: a. It alters the levels of bradykinin b. It alters the levels of epinephrine c. It prevents the formation of ANGII d. It alters the levels of serotonin A 45-year-old man presents to his physician for a routine health maintenance visit. He reports that he has experienced intermittent heart palpitations. He denies any chest pain, dyspnea on exertion. On physical examination, the patient is well appearing and in no distress. His blood pressure is 110/79 mm Hg. Auscultation of his chest while sitting reveals a late systolic click associated with a high pitched, late systolic murmur. His ECG is normal; a transesophageal echocardiogram shows a thin leaflike structure entering the inferior left atrium during systole. Which of the following correctly identifies the thin leaflike structure? Select one: a. Pulmonary Semilunar Valve b. Aortic Semilunar Valve c. Tricuspid Valve d. Mitral Valve A 65-year-old man presents to the emergency department complaining of a sudden onset of substernal chest pain that radiates to his shoulder. It began while he was watching TV on his couch. He describes that the paramedics administered nitroglycerin spray (an NO donor), which alleviated his chest pain for about 20 minutes, but then the pain returned. The patient experienced hypotension and dizziness while en route to the ER. When examined in the emergency department, the patient states that he has had similar pain with exercise in the past, but it always vanished with rest. A cardiac troponin test is negative and his blood pressure is 135/70. Why did the patient experience temporary hypotension and dizziness? Select one: a. The patient experienced a short-term vasodilation systemically due to the administration of nitroglycerin. b. The patient vasoconstricted the cerebral blood vessels inappropriately to the administration of nitroglycerin, resulting in a temporary decrease of blood to the brain. c. The patient was having a myocardial infarction and lost temporary pumping capacity of the heart. d. The patient was suffering from an overactivation of the sympathetic nervous system in response to the pain. A 35-year-old woman presents to her internist complaining of recent episodes of weakness and tingling in her extremities. She also complains of polyuria and polydipsia. Her blood pressure on the day of this visit is 160/100 mm Hg. Laboratory studies reveal a serum sodium level of 147 mEq/L (hypernatremia), a potassium level of 2.8 mEq/L (hypokalemia), and very low serum renin activity. What is the most likely diagnosis and treatment? Select one: a. An ANP-secreting tumor and candesartan b. An ADH-secreting tumor and furosemide c. Hyperaldosteronism and spironolactone d. Hyperaldosteronism and captopril A 50-year-old woman presents to the emergency department complaining of 2 hours of vertigo, headache, palpitations, and blurry vision. She has a history of occasional tension headaches but no significant cardiac history. She does not smoke and has no history of hypertension. At presentation, her blood pressure is 200/140 mm Hg, her heart rate is 120/min, and she is afebrile. Her skin is sweaty and flushed. Noncontrast imaging of the brain is negative for blood or other mass lesions. Laboratory testing reveals increased plasma epinephrine and norepinephrine. Results of a serum thyroid-stimulating hormone test are within normal limits. Twenty-four-hour urine catecholamines are elevated. Pheochromocytoma is suspected. Which of the following pharmacological agents could be administered to reduce blood pressure? Select one: a. Albuterol b. Phenylephrine c. Propranolol d. Neostigmine
Suman K.
A 5'6", 210 lb., 64-year-old male business executive had a physical prior to his retirement from corporate work. His blood pressure was >180/115 on three separate days. Further examination showed normal to low plasma renin activity, elevated total peripheral resistance (TPR), cardiac output (CO) of 7.2 L/min, x-ray evidence of left ventricular hypertrophy, retinal hemorrhages, and mild polyuria. Recommended therapy was weight reduction to his ideal level, a low-salt diet (<2 gm/day sodium), prudent exercise, and a reduction in alcohol consumption (<3 oz whiskey/day). This change in lifestyle did little to change the condition. Medication was initiated in the form of an oral diuretic and progressed to a beta-blocker; eventually a vasodilator was included to reduce the blood pressure to <140/90. Explain the sites of action for the three pharmacologic agents prescribed for this individual. Oral diuretic: Beta-blocker: Vasodilator: What was the cause of the retinal hemorrhages? Define and indicate the causes of the cardiac hypertrophy and polyuria.
Adi S.
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