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Atenolol
32%
127/399
Furosemide
8%
31/399
Hydrochlorothiazide
19%
75/399
Nifedipine
Nitroglycerin
31%
122/399
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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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