Question 42

42.  Your patient is a 23 year old female with pregnancy induced hypertension that is 22 weeks pregnant.  She is on labetolol 200 mg BID.  She is in your office for a routine visit and she feels fine.  Her urine is negative for protein and otherwise normal.  Her CBC and CMP are normal.  Her vitals are as follows:  BP 168/102, HR-49, Temp-98.6, RR-16.  She has no edema.  Which of the following is the best management option.

A.  Increase dose of labetolol
B.  Recommend delivery
C.  Start Hydralazine
D.  Start lisinopril

Answer 41

41.  Choice B is the correct answer.  The dry cough is coming from the elevated bradykinnin associated with ACE inhibitors.  Lowering the dose usually does not take this side effect away and may not give you adequate blood pressure control.  Switching the patient to diovan, the angiotensin receptor blocker, uses a very similar mechanism but does not elevated bradykinnin levels and will likely give you the same blood pressure control.  The patients HR is too low to start metoprolol.  Usually beta blockers are not start on patients with HR less than 60.  Albuterol is not indicated because the patients clinical picture is not consistent with bronchospasm.

Question 41

41.  Your patient is a 45 year old female who is in your office for a check up for her blood pressure.  She has been taking lisinopril for two months 20 mg daily.  Her vitals are as follows BP 110/68, HR 52, RR-16 Temp-97.6.  She states she feels great but reports a nagging dry cough.  Her lungs are clear and she reports no recent illness or fever.  She is not short of breath and she is a non smoker.  Which of the following is the best management options?

A.  Lower the dose of lisinopril to 10 mg daily
B.  Start diovan at the equivalent dose and stop lisinopril
C.  Start the patient on metoprolol
D.  Continue the lisinopril and start the patient on albuterol MDI.  This is from bronchospasm.