Question

Mary is 52-year-old female with HTN on Lisinopril 40mg and well controlled. She comes to the office because she has had a sore throat for several days, which is found to be strep negative. She has no fever or cough. What should you recommend for her sore throat and stuffy nose and why? What precautions should you give her regarding over-the-counter medication because of her medical history and why?

Answer 1

I would rather change her drug of ACE Inhibitors(Lisinopril) which the Mary was taking to control her Hypertension and I would replace it with the ARBs ( Angiotensin Receptor Blockers)- Such as Telmisartan , Losartan ,Candesartan etc. Because her symptoms of sore Throat and stuffy nose are not due to any Infection as she was Strep Negative rather It was due to the bradykinin and substance P accumulation seen in patients taking ACE-inhibitors which also explains the nasal mucosa congestion seen in these patients. Histamine release from mast cells due to bradykinin can also potentiate this reaction. Leukotrienes and prostaglandin E2 and I2 can potentiate this inflammatory reaction as well. So in these patients we can see Rhinitis, post -nasal drip that can cause Sore throat occurs oftenly .

The precautions Mary should take regarding her Over-the-counter Medications because of her past Medical History is that she shouldn't take Over-the-counter Medicines for her sore throat unnecessarily as she is not having sore throat and nasal stiffness due any infection rather it was due to the Lsinopril medication that she was taking so she should avoid taking the Over-the-counter drugs.