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72 y.o woman has been on hydrochlorothiazide 12.5 mg for many years to control her stage 2
hypertension. Her BP at this visit is 168/ 96. She has pain to her right hip/ knees and takes 400mg
, Ibuprofen 3X daily. Which of the following is the appropriate education to give her about Ibuprofen on
her disease?
A. Increases the chances of adverse effects on her health.
B. Inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic.
C. Prolongs the therapeutic effects of hydrochlorothiazide and other diuretics
D. None of the above are true - correct ans:B. It inhibits the effect of renal prostaglandins and blunts the
effectiveness of the diuretic: NSAIDS and ASA inhibit vasodilatory effects of prostaglandins which
predisposes the kidney to ischemia. NSAIDS and diuretics can cause acute pre-renal failure by decreasing
renal blood flow
Which of the following anti-hypertensive medications has beneficial effects for an elderly female with
osteoporosis?
A. Calcium Channel Blocker
B. Angiotensin-converting enzyme (ACE) inhibitor
C. Beta-Blocker
D. Diuretic - correct ans:A. Calcium Channel blocker: these work by blocking the calcium channels in the
heart muscle and blood vessels, thereby keeping more calcium in the bones.
Which of the following lab tests is used in primary care to evaluate renal function?
A. Electrolyte panel
B. Creatinine
C. Alkaline Phosphatase
D. Blood Urea Nitrogen (BUN) - correct ans:B. Creatinine
A 63 y.o. patient presents with a 10 year history of poorly controlled hypertension presents with a
cluster of physical exam findings. Which of the following indicates target organ damage commonly seen
in hypertensive patients?
A. Pedal Edema, hepatomegaly and enlarged kidneys