Adverse Effects of Drugs IV

Cardiovascular System


{"ops":[{"insert":"A 75-year-old man comes to the physician because of a 6-month history of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, and peripheral edema. He has type 2 diabetes mellitus, hypertension, dyslipidemia, atrial fibrillation, and past ischemic stroke. Medications include ramipril, diltiazem, apixaban, rosuvastatin and metformin\/empagliflozin. Pulmonary examination shows crackles at both lung bases. There is pitting edema of the lower legs and ankles. An echocardiogram shows an ejection fraction of 35%. Which of the following medications should be stopped in this patient?"},{"insert":"\n"}]}

Background

{"ops":[{"insert":"\n"}]}

(A)

Apixaban
{"ops":[{"insert":"\n"}]}

(B)

Carvedilol
{"ops":[{"insert":"\n"}]}

(C)

Empagliflozin
{"ops":[{"insert":"\n"}]}

(D)

Diltiazem
{"ops":[{"insert":"\n"}]}

(E)

Ramipril
{"ops":[{"insert":"\n"}]}

References

{"ops":[{"insert":"WRITING COMMITTEE MEMBERS., YANCY CW, JESSUP M, BOZKURT B, BUTLER J, CASEY DE JR, DRAZNER MH, FONAROW GC, GERACI SA, HORWICH T, JANUZZI JL, JOHNSON MR, KASPER EK, LEVY WC, MASOUDI FA, MCBRIDE PE, MCMURRAY JJ, MITCHELL JE, PETERSON PN, RIEGEL B, SAM F, STEVENSON LW, TANG WH, TSAI EJ, WILKOFF BL, AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION\/AMERICAN HEART ASSOCIATION TASK FORCE ON PRACTICE GUIDELINES.. 2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on practice guidelines. Circulation [online] 2013 Oct 15, 128(16):e240-327 [viewed 03 June 2019] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23741058"},{"insert":"\n","attributes":{"list":"ordered"}},{"insert":"FITCHETT D, ZINMAN B, WANNER C, LACHIN JM, HANTEL S, SALSALI A, JOHANSEN OE, WOERLE HJ, BROEDL UC, INZUCCHI SE, EMPA-REG OUTCOME\u00ae TRIAL INVESTIGATORS.. Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME\u00ae trial. Eur Heart J [online] 2016 May 14, 37(19):1526-34 [viewed 17 June 2019] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26819227"},{"insert":"\n","attributes":{"list":"ordered"}}]}

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