Question
A 50-year-old man comes to the physician because of swelling of his legs for 2 months. Three months ago, he was diagnosed with hypertension and started on a new medication. His blood pressure is 145/95 mm Hg. Physical examination shows 2+ edema in both lower extremities. Laboratory studies are within the reference ranges. This patient was most likely treated with which of the following drugs?
| A. |
Lisinopril
|
| B. |
Spironolactone
|
| C. |
Hydrochlorothiazide
|
| D. |
Amlodipine
|
Show Answer
|
Correct Answer � D
Explanation
|
|
Ans-D-Amlodipine
Lisinopril
ACE inhibitors (e.g., lisinopril) inhibit the conversion of angiotensin I to angiotensin II by ACE, thereby decreasing systemic vasoconstriction and renal reabsorption of water and sodium. While ACE inhibitors are used in the treatment of hypertension, common adverse effects include cough, angioedema, and hyperkalemia, but not peripheral edema.
Spironolactone
Aldosterone receptor antagonists (e.g., spironolactone) block aldosterone-mediated sodium and water reabsorption in the distal convoluted tubule. While aldosterone receptor antagonists are used in the treatment of hypertension, common adverse effects include hyperkalemia and antiandrogen effects (e.g., gynecomastia), but not peripheral edema.
Hydrochlorothiazide
Thiazide diuretics (e.g., hydrochlorothiazide) inhibit the reabsorption of sodium in the distal convoluted tubule (which increases the excretion of sodium, water, potassium, and hydrogen ions). While thiazide diuretics are used in the treatment of hypertension, common adverse effects include hypokalemia, hyponatremia, hyperglycemia, hyperlipidemia, hyperuricemia, and hypercalcemia, but not peripheral edema.
Amlodipine
Dihydropyridine calcium channel blockers such as amlodipine inhibit voltage-dependent slow calcium channels. Blockage of these channels results in a decrease in the intracellular calcium that is needed for electromechanical coupling and muscle contraction. This causes vascular smooth muscle relaxation, which leads to systemic vasodilation and a decrease in blood pressure. Other common side effects of CCBs include headaches, dizziness, facial flushing, and reflex tachycardia.
