tommyk
05-20-2006, 04:34 PM
Hy 2230
A 60-year-old man presents to his physician for a preoperative evaluation. He has been a long-time patient in this office and has been treated for hypertension and gastritis. He has been scheduled for an elective open cholecystectomy in 2 days. He currently takes omeprazole for his gastritis and thiazide for his hypertension daily. He smokes two packs of cigarettes per day. His home blood pressure log shows that his systolic pressures range from 150 to 190 mm Hg, and his diastolic pressures range from 80 to105 mm Hg, indicating that his blood pressure may be not adequately controlled for the surgical procedure. Which of the following medications is most appropriate in the perioperative period for added blood pressure control?
1-Calcium channel blocker
2-Captopril
3-Nifedipine
4-Clonidine
5-Metoprolol
6-Prazosin
ans is #5) There is an extensive body of literature indicating that beta blockers given to non-cardiac surgical patients who are at risk of cardiac events are associated with a more favorable outcome in terms of postoperative cardiovascular morbidity and mortality. This patient has somewhat poorly controlled hypertension, as well as at least three cardiovascular risk factors (hypertension, tobacco, age). Ideally, one would like to have better control of the blood pressure and to reduce any risk for adverse perioperative events. Beta blockers can achieve both of these endpoints.Captopril is an ACE inhibitor that has good efficacy in the treatment of hypertension. This class of drugs has also been shown to prolong survival in patients with congestive heart failure. Clonidine is a central alpha-2 receptor agonist that works to attenuate sympathetic outflow and thus lower blood pressure. Although it is a reasonably efficacious drug, it is associated with rebound hypertension if abruptly discontinued. It has no role in the perioperative management of blood pressure. Nifedipine is a calcium channel blocker that has reasonable efficacy in treating hypertension. There is no benefit to giving this agent in the perioperative period.
A 60-year-old man presents to his physician for a preoperative evaluation. He has been a long-time patient in this office and has been treated for hypertension and gastritis. He has been scheduled for an elective open cholecystectomy in 2 days. He currently takes omeprazole for his gastritis and thiazide for his hypertension daily. He smokes two packs of cigarettes per day. His home blood pressure log shows that his systolic pressures range from 150 to 190 mm Hg, and his diastolic pressures range from 80 to105 mm Hg, indicating that his blood pressure may be not adequately controlled for the surgical procedure. Which of the following medications is most appropriate in the perioperative period for added blood pressure control?
1-Calcium channel blocker
2-Captopril
3-Nifedipine
4-Clonidine
5-Metoprolol
6-Prazosin
ans is #5) There is an extensive body of literature indicating that beta blockers given to non-cardiac surgical patients who are at risk of cardiac events are associated with a more favorable outcome in terms of postoperative cardiovascular morbidity and mortality. This patient has somewhat poorly controlled hypertension, as well as at least three cardiovascular risk factors (hypertension, tobacco, age). Ideally, one would like to have better control of the blood pressure and to reduce any risk for adverse perioperative events. Beta blockers can achieve both of these endpoints.Captopril is an ACE inhibitor that has good efficacy in the treatment of hypertension. This class of drugs has also been shown to prolong survival in patients with congestive heart failure. Clonidine is a central alpha-2 receptor agonist that works to attenuate sympathetic outflow and thus lower blood pressure. Although it is a reasonably efficacious drug, it is associated with rebound hypertension if abruptly discontinued. It has no role in the perioperative management of blood pressure. Nifedipine is a calcium channel blocker that has reasonable efficacy in treating hypertension. There is no benefit to giving this agent in the perioperative period.