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Review Question - QID 100600

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QID 100600 (Type "100600" in App Search)
A 60-year-old woman presents to her primary care physician for a wellness checkup. She has a past medical history of hypertension and was discharged from the hospital yesterday after management of a myocardial infarction. She states that sometimes she experiences exertional angina. Her temperature is 99.5°F (37.5°C), blood pressure is 147/98 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is within normal limits. Which of the following is the best next step in management?

Atenolol

32%

127/399

Furosemide

8%

31/399

Hydrochlorothiazide

19%

75/399

Nifedipine

8%

31/399

Nitroglycerin

31%

122/399

Select Answer to see Preferred Response

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This patient is presenting after a myocardial infarction. She should be started on mortality-lowering drugs which include beta-blockers like atenolol.

Myocardial infarctions warrant aggressive medical intervention in order to prevent future episodes. Mortality-lowering interventions include aspirin, statins, beta-blockers, ACE-inhibitors/ARB's, and exercise/weight loss. Beta-blockers exert their mortality-lowering benefits by decreasing heart rate and cardiac contractility (via beta-1 receptor blockade) thus decreasing the workload and oxygen requirements of the myocardium.

Incorrect Answers:
Answer 2: Furosemide (a loop diuretic) may manage this patient's blood pressure but does not lower mortality. The nephron can adapt to this medication thus mitigating its long-term effects.

Answer 3: Hydrochlorothiazide is a thiazide diuretic that is first line and mortality lowering in hypertension; however, may not be the best initial medication to give a patient after a myocardial infarction where beta-blockers should be started to reduce cardiac workload. Thiazide diuretics may be started after beta-blockers.

Answer 4: Nifedipine is a calcium channel blocker than is only indicated for managing blood pressure but would not reduce mortality.

Answer 5: Nitroglycerin is indicated for treating angina but does not lower mortality.

Bullet Summary:
Mortality-lowering medications in ischemic heart disease include aspirin, statins, beta-blockers, and ACE-inhibitors/ARB's.

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