Snapshot A 67-year-old Caucasian man presents to his primary care physician for follow-up of his hypertension. He was recently started on a lisinopril for chronic hypertension. He has been monitoring his blood pressure at home and they have all been within the normal range. However, he reports a new cough that began a few days after starting lisinopril. Introduction Mechanism of action inhibits angiotensin-converting enzyme (ACE) ↓ angiotensin II (AT II) recall that AT II increases blood pressure by constricting renal and peripheral vasculature and increasing sodium reasorption in the kidney ↓ AT II prevents constriction of efferent arterioles and ↓ glomerular filtration rate (GFR) ↓ negative feedback and ↑ renin ↑ bradykinin, a potent vasodilator ACE normally degrades/inactivates bradykinin Clinical use hypertension myocardial infarction prevents heart remodeling heart failure (this medication decreases mortality) proteinuria diabetic nephropathy Toxicity cough angioedema due to ↑ bradykinin contraindicated in patients with C1 esterase inhibitor deficiency teratogenic effects on fetuses disrupts fetal renal development contraindicated in pregnant woman ↑ creatinine (↓ GFR) contraindicated in bilateral renal artery stenosis because ACE inhibitors may further ↓ GFR and cause renal failure hyperkalemia hyponatremia metabolic acidosis hypotension Medications captopril lisinopril enalapril ramipril
QUESTIONS 1 of 10 1 2 3 4 5 6 7 8 9 10 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.RL.17.4768) A 64-year-old African American female comes to the physician’s office for a routine check-up. The patient’s past medical history is significant for hypertension, diabetes, and osteoarthritis in her right knee. Her medications include metformin, glimepiride, lisinopril, metoprolol, hydrochlorothiazide, and ibuprofen as needed. Her only complaint is an unremitting cough that started about 3 weeks ago and she has noticed some swelling around her mouth. The drug most likely responsible for her recent symptoms most directly affects which part of the kidney? Tested Concept QID: 109082 Type & Select Correct Answer 1 Distal convoluted tubule 8% (15/185) 2 Juxtaglomerular cells 13% (24/185) 3 Afferent arteriole 13% (24/185) 4 Efferent arteriole 57% (106/185) 5 Collecting duct 5% (10/185) M 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.RL.15.20) A 66-year-old male with a history of diabetes, hypertension, and chronic kidney disease presents to the emergency department with severe fatigue, muscle weakness, and palpitations. He states that it seemed to start yesterday and has progressed since that time. The emergency physician obtains an EKG which is demonstrated in Figure A. The patient comments that a few days ago he visited his primary care physician during which some of his blood pressure medications were changed. Which of the following medications was most likely added during that visit? Tested Concept QID: 105630 FIGURES: A Type & Select Correct Answer 1 Lisinopril 41% (48/118) 2 Furosemide 17% (20/118) 3 Hydrochlorothiazide 19% (22/118) 4 Nifedipine 14% (16/118) 5 Hydralazine 8% (9/118) M 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept (M1.RL.14.75) A 46-year-old woman with a history of type II diabetes mellitus is started on lisinopril for newly diagnosed hypertension by her primary care physician. At a follow-up appointment several weeks later, she reports decreased urine output, and she is noted to have generalized edema. Her creatinine is elevated compared to baseline. Given her presentation, which of the following changes in renal arteriolar blood flow and glomerular filtration rate (GFR) have likely occurred? Tested Concept QID: 106863 Type & Select Correct Answer 1 Renal afferent arteriole vasoconstriction; decreased GFR 29% (20/70) 2 Renal afferent arteriole vasodilation; increased GFR 3% (2/70) 3 Renal efferent arteriole vasoconstriction; increased GFR 13% (9/70) 4 Renal efferent arteriole vasodilation; decreased GFR 53% (37/70) 5 Renal efferent arteriole vasodilation; no change in GFR 1% (1/70) M 4 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (M1.RL.14.22) A 47-year-old female with a history of mild asthma, type II diabetes, hypertension, and hyperlipidemia presents to clinic complaining of swelling in her lips (Image A). She has had no changes to her medications within the past two years. Vital signs are stable. Physical exam is notable for significant erythema around and swelling of the lips. The remainder of her exam is unremarkable. What is the mechanism of action of the drug that has caused her current symptoms? Tested Concept QID: 104233 FIGURES: A Type & Select Correct Answer 1 Inhibition of angiotensin-converting enzyme 71% (61/86) 2 Inhibition of HMG-CoA reductase 13% (11/86) 3 Stimulation of the Beta 2 receptor 2% (2/86) 4 Inhibition of the Na/K/Cl triple transporter of the thick ascending limb 10% (9/86) 5 Inhibition of voltage-dependent L-type calcium channels 2% (2/86) M 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept (M1.RL.13.10) A 58-year-old male with a history of congestive heart failure and hypertension comes to you with the chief complaint of new-onset cough as well as increased serum potassium in the setting of a new medication. Which of the following medications is most likely responsible for these findings? Tested Concept QID: 100964 Type & Select Correct Answer 1 Furosemide 3% (4/123) 2 Metoprolol 2% (2/123) 3 Amiodarone 8% (10/123) 4 Digoxin 3% (4/123) 5 Lisinopril 82% (101/123) M 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review tested concept (M1.RL.13.82) A 78-year-old Caucasian male actor presents to your office complaining of a dry, non-productive cough. He has a history of hypertension, diabetes, and coronary artery disease and he follows a complicated regimen of medications to treat his multiple co-morbidities. Which of the following medications is most likely to be associated with his chief complaint? Tested Concept QID: 100598 Type & Select Correct Answer 1 Aspirin 0% (0/44) 2 Lisinopril 95% (42/44) 3 Hydrochlorothiazide 2% (1/44) 4 Metoprolol 0% (0/44) 5 Nifedipine 2% (1/44) M 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept (M1.RL.12.246) A physician is choosing whether to prescribe losartan or lisinopril to treat hypertension in a 56-year-old male. Relative to losartan, one would expect treatment with lisinopril to produce which of the following changes in the circulating levels of these peptides? Tested Concept QID: 100762 Type & Select Correct Answer 1 Bradykinin increase; angiotensin II decrease 81% (57/70) 2 Renin decrease; angiotensin 1 increase 1% (1/70) 3 Aldosterone increase; bradykinin decrease 4% (3/70) 4 Renin decrease; angiotensin II increase 6% (4/70) 5 Angiotensin II increase; bradykinin decrease 6% (4/70) M 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept