A 48-year-old woman comes to your primary care clinic complaining of a facial rash,joint pains and photosensitivity. In the review of systems, she reports fever, hair loss, headaches, flushing, palpitations, feeling low, tingling sensation in both feet and peripheral edema. While reviewing her medications, she informs you that she started on a new medication 4 months ago. On physical examination, you observe that the patient has flushing of her cheeks with a distinct butterfly rash over her nose and cheeks. Her temperature is 99 °F (37.2 °C), heart rate is 108 beats/min, blood pressure is 148/98 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 98% on room air. Laboratory studies are significant for the presence of anti-histone antibodies. Which of the following medications is most likely causing her distress?
A 72 year-old male presents to the emergency room with severe chest pain, nausea and vomiting. His past medical history is significant for hypertension and he has been taking lisinopril 20 mg daily for hypertension. His ECG displayed ST segment elevations in precordial leads. Lab tests revealed elevated troponin. His temperature is 99 ⁰ F, heart rate is 97 beats per minute, respiratory rate is 17 breaths per minute, and blood pressure is 220/140 mm Hg. Which of the following is the most effective way to reduce his blood pressure?
A 54 year-old woman presents to your cardiology clinic complaining of weakness, fatigue, palpitations and lightheadedness to the point of passing out while having dinner. Her medical history is significant for congestive heart failure and she was started on a new medication two weeks ago to improve her shortness of breath. On physical examination she has muscle weakness and depressed deep tendon reflexes. Laboratory tests revealed a potassium level of 6.4 mEq/Liter. ECG showed tall, peaked t-waves with loss of some p waves. Which of the following medications was this patient most likely given?
A 42 year-old male comes to your primary care office complaining of hearing loss. He was started on a new medication 8 months ago. His hearing loss progressively became worse over the time. Two months ago, he reduced the dose of the medication, yet his hearing has not improved. Of the following, which group of medications can cause ototoxicity independent of their dose?
A 68 year-old woman comes to your primary clinic complaining of ringing in the ears, hearing loss, lightheadedness, and a feeling that something is ‘stuffed in my ears’. She reports that these symptoms started after she was initiated on a ‘kidney pill’. Of the following, which is the most likely culprit?
A 45 year-old African-American patient comes to your office for the treatment of his blood pressure because last week he was disqualified to work as a commercial truck operator because of his uncontrolled hypertension. He has no other medical problems. His physical examination is unremarkable. Which of the following should be the initial medication in this patient?
Christina, a 55-year-old woman, presents to her primary care physician with a blood pressure reading of 150/90 mmHg. She has a history of hypertension but has not been consistently taking her medications. The physician discusses the importance of controlling blood pressure to reduce the risk of heart disease, stroke, and kidney disease. She is started on a diuretic to lower her blood pressure. She is educated about the potential side effects of the medication. She is advised to monitor her blood pressure at home and report any side effects to her doctor. Of the following, which diuretic is most commonly associated with development of gout?
A 54-year-old man presents to the clinic for a pre-employment physical examination. He has no complaints other than ‘occasional coughs and colds’. His only concern is elevated blood pressure for the last 4 weeks. He made some lifestyle changes including exercise, weight loss, smoking cessation and a low-salt diet. His temperature is 99 ⁰ F, heart rate is 72 beats per minute, respiratory rate is 14 breaths per minute, and blood pressure is 160/90 mm Hg. You prescribe hydrochlorothiazide to treat his hypertension. Of the following, which is the mechanism of action of this medication?
