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-----q---- - samomcos
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10-13-2009, 02:21 PM
an 82 yo woman with a h/o RF develops CHF. PE reveals peripheral edema. Lab studies show a creatinine clearance of 17 ml/min. WHich of the following should be included in her treatment regimen?
1) Frusemide 2) HCTZ 3) Indapamide 4) Spironolactone
10-13-2009, 02:33 PM
4?? isn't spironolactone good for patients w/ CHF b/c it prevents cardiac remodeling
10-13-2009, 04:21 PM
i think loop diuretic bcoz it acts upto 10 ml/min.
pls.correct me if i m wrong.
10-13-2009, 04:31 PM
yeah, answer is frusemide..... bcz it can act till 10ml/min cr.cl.
that's the main point of interest here... the others - thiazides and K-sparing siuretics can act only upto a cr.cl. of 40ml/min.
10-13-2009, 04:41 PM
Spironolactone okey here is response... 1) frusemide... (Wrong) it is a loop diuretic which will inhibit 2Cl/K/Na in ascending limb of loop of henle, loop diuretics IMPROVES symptoms, but NOT survival 2) will block Na/Ca symporters in DCT, only small amount of Na is left in DCT .. thus no Correct answer is .. Spironolactone.. it will inhibit aldosterone... because elevated level of Renin Angiotensin will lead to increase in Aldosterone, which will lead to ven. remodling and cardiac fibrosis
10-13-2009, 05:11 PM
syed312..... the point of focus in the Q is GFR....... at this low GFR only loops wd work
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