A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension.
Which drug will most likely be ordered for this patient?
Clonidine.
Prazosin.
Diltiazem.
Captopril.
The Correct Answer is B
Choice A rationale
Clonidine is a centrally acting alpha-2 adrenergic agonist. While it is an effective antihypertensive, it has been associated with adverse effects on the liver, including hepatitis and elevated liver enzymes. For a patient with a history of cirrhosis, which involves irreversible liver damage and impaired function, a drug with potential hepatotoxicity is a poor choice as it could worsen the underlying liver disease.
Choice B rationale
Prazosin is an alpha-1 adrenergic blocker. It is a suitable choice for this patient. Unlike other antihypertensives, it does not typically cause adverse effects on the liver or pancreas. Its mechanism of action, causing vasodilation by blocking alpha-1 receptors, is not known to exacerbate either pancreatitis or cirrhosis. Therefore, it is a safe and effective option given the patient's co-morbidities.
Choice C rationale
Diltiazem is a calcium channel blocker. While generally safe, some calcium channel blockers have been associated with potential exacerbation of pancreatic inflammation. Although diltiazem is not the most common culprit, its use should be approached with caution in a patient with a history of pancreatitis due to the potential for pancreatic adverse effects. This makes it a less ideal choice compared to a drug with no known pancreatic side effects.
Choice D rationale
Captopril is an ACE inhibitor. This class of drugs has been associated with a potential risk of hepatotoxicity, including cholestatic jaundice and liver failure, although these are rare. In a patient with pre-existing cirrhosis, the liver's ability to metabolize drugs is already compromised, which increases the risk of drug accumulation and potential toxicity. Therefore, it would be a less favorable choice due to the risk of worsening liver function.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Benzodiazepines are central nervous system depressants that enhance the effect of the neurotransmitter GABA. Alcohol is also a central nervous system depressant. Combining these substances can lead to a dangerous synergistic effect, resulting in profound sedation, respiratory depression, and potentially fatal overdose. Therefore, patients must be explicitly advised to avoid alcohol.
Choice B rationale
Benzodiazepines act by enhancing the effects of gamma-aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the central nervous system. This action leads to a generalized decrease in neuronal excitability, which is responsible for their anxiolytic, sedative, and hypnotic effects. As a result, common side effects include drowsiness and dizziness, which can impair a patient's ability to drive or operate machinery.
Choice C rationale
Benzodiazepine absorption is generally not significantly affected by food. While some medications may have improved absorption with meals, benzodiazepines do not require this. Taking the medication with or without food does not substantially alter its bioavailability or efficacy, so this instruction is not a necessary part of patient education regarding this drug class.
Choice D rationale
Abrupt discontinuation of benzodiazepines can lead to withdrawal symptoms, which can be severe and potentially life-threatening. These symptoms may include rebound anxiety, insomnia, seizures, and psychosis. The body adapts to the presence of the drug, and sudden removal can cause a state of hyper-excitability. Therefore, the medication should always be tapered under the guidance of a healthcare provider.
Correct Answer is D
Explanation
Choice A rationale
Reducing physical activity is not a recommended lifestyle modification for enhancing the effectiveness of antihypertensive medication. Regular physical activity, such as aerobic exercise, strengthens the cardiovascular system, helps manage weight, and can directly lower blood pressure, thereby complementing the effects of medication.
Choice B rationale
Increasing dietary sodium intake is detrimental to blood pressure control. High sodium intake leads to increased fluid retention, which raises blood volume and cardiac output, thereby increasing blood pressure. This counteracts the effect of antihypertensive medication and is a known risk factor for cardiovascular disease.
Choice C rationale
Limiting fluid intake is not a universally recommended strategy for all patients on antihypertensive medication. While some conditions like heart failure may require fluid restriction, this is not a general rule for hypertension management. Maintaining adequate hydration is important for overall health and for the proper function of various bodily systems.
Choice D rationale
Maintaining a low-sodium diet and managing weight are two critical lifestyle modifications that enhance the effectiveness of antihypertensive medication. A low-sodium diet reduces fluid retention and blood volume, while weight management decreases the strain on the heart and blood vessels. These actions work synergistically with medication to lower blood pressure.
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