Question

A client has fallen in part due to low blood pressure. Which of the medications listed below may have contributed to the drop in his blood pressure?

Answers:

metolazone, a thiazide agent

digoxin, an inotropic agent

simvastatin, an anti-lipemic agent

clopidogrel, an anti-platelet agent

nifedipine, a calcium channel blocker for angina

candesartan, an ARB (angiotensin receptor blocker)

Answer 1

*Metolazone-because it interfers with renal tubular mechanism of electrolyte reabsorption.it inhibits sodium reabsorption in cortical diluting site and proximal convulted tubule site.The increased delivery of sodium to distal tubule site results in increased potassium excretion which promotes diuretic property .over loss of urine results in fall in blood pressure.

*Nifedipine-it decreases the arterial smooth muscle contraction and subsequent vasoconstriction by inhibiting the calcium influx,which leads to dilation of coronary and systemic arteries causes decreased total peripheral resistance and decreased systemic blood pressure.

*Candesartan-it selectively blocks the binding of angiotensin2 in vascular smooth muscles,this inturn inhibits angiotensin1 mediated vasoconstrictive and aldosterone secreting effects of angiotenin2 and results in overall decrease in blood pressure by enhancing sodium and water excretion while decreasing potassium excretion.