HTN drug rx q - quansar

[ArchivalUser]

A 59-year-old woman comes to the clinic for a routine followup visit for high blood pressure. At her last visit she was found to have stage one hy pertension and was started on a salt-restricted diet and an exercise plan. Today she reports feeling well and believes the diet and exercise have been a success. She is extremely pleased with a 10-pound weight loss over the last 6 months. Aside from hypertension, she has a history of migraines and Raynaud phenomena, both of which are intermittent but bothersome. She also has had asthma most of her life, which requires the use of a rescue inhaler once or twice a week. Aside from her
inhaler she takes no prescription medications, though she does take over the counter high-dose acetaminophen when a migraine occurs. Her blood pressure today is found to be
155/85 mm Hg. Which of the following is the most efficacious first treatment for this patient™s condition?

A. ACE inhibitor
B. Alpha blocker
C. Beta blocker
D. Calcium channel blocker
E. Loop diuretics

[ArchivalUser]

d....?

[ArchivalUser]

D..

[ArchivalUser]

why d??? shouldn't diuretics the first type of drug to give?

hope08, what's your reasons giving d first

[ArchivalUser]

Because pt has Raynaud phenomena, it is better to use CCA instead of beta blocker (contraindication for asthma)
Calcium antagonists have also been used for the prevention and treatment of various dermatologic diseases such as erythromelalgia, idiopathic- or CREST-related calcinosis cutis, primary and secondary Raynaud phenomenon, chilblains, chronic anal fissures, keloids, and burn scars. T

[ArchivalUser]

Thiazide is a first try, not loop diuretic.

[ArchivalUser]

D.
looking at HTN guidelines, give A (ACEi or ARB) or B (beta blocker) if younger than 55 and C (CCB) or D (diuretics) if older than 55 or black.
and then this woman has raynaud's. therefore: D

[ArchivalUser]

thanks hope08 and mtas, very nice summary