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Calcium channel blockers are recommended for managing hypertension in a patient preparing for knee replacement surgery. CCBs effectively lower blood pressure through vasodilation with a low risk of side effects. In contrast, thiazide diuretics, beta-blockers, and ACE inhibitors could cause issues like electrolyte imbalances, hypotension, or impaired wound healing in the perioperative period. Delaying treatment would also increase the risk of cardiovascular complications during surgery.

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204 views1 page

UKMLA Qbank

Calcium channel blockers are recommended for managing hypertension in a patient preparing for knee replacement surgery. CCBs effectively lower blood pressure through vasodilation with a low risk of side effects. In contrast, thiazide diuretics, beta-blockers, and ACE inhibitors could cause issues like electrolyte imbalances, hypotension, or impaired wound healing in the perioperative period. Delaying treatment would also increase the risk of cardiovascular complications during surgery.

Uploaded by

drjames730
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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The correct answer is to begin therapy with a calcium channel blocker (CCB.

Hypertension is a common condition encountered in perioperative medicine


and can increase the risk of perioperative cardiovascular complications. In
this clinical scenario, the patient has essential hypertension, as there is no
evidence of end-organ damage. The goal of hypertension management in the
perioperative period is to optimize blood pressure control while minimizing
the risk of adverse effects.

Calcium channel blockers (CCBs) are a suitable choice for managing


hypertension in the perioperative period. They are effective in reducing blood
pressure and have a favorable side effect profile. CCBs cause arterial
vasodilation by inhibiting the influx of calcium ions into vascular smooth
muscle cells, leading to decreased systemic vascular resistance. They are
particularly useful in patients with comorbid conditions, such as diabetes
mellitus, as they do not impair glucose metabolism.

Initiate treatment with a thiazide diuretic: Thiazide diuretics are effective in


reducing blood pressure, but they may cause volume depletion, electrolyte
imbalances (e.g., hypokalemia), and can worsen glucose control in patients
with diabetes. These factors make them less suitable for this patient's
management in the perioperative period.

Start treatment with a beta-blocker: Beta-blockers are commonly used for


hypertension management, but they may have adverse effects in the
perioperative period. Beta-blockers can cause bradycardia, hypotension, and
bronchospasm. Given the patient's scheduled knee replacement surgery, it is
important to avoid agents that may cause adverse effects on the
cardiovascular system or impair wound healing.

Commence therapy with an angiotensin-converting enzyme (ACE inhibitor:


ACE inhibitors are effective antihypertensive agents, but they can cause
intraoperative hypotension and compromise renal function in the
perioperative period. Therefore, they are generally discontinued
preoperatively or held on the day of surgery.

Delay treatment until the postoperative period: Uncontrolled hypertension


increases the risk of perioperative cardiovascular complications. Initiating
antihypertensive therapy before surgery allows for adequate blood pressure
control during the perioperative period. Delaying treatment until the
postoperative period is not recommended, as it may lead to adverse
cardiovascular events during surgery.

In summary, in the management of essential hypertension in the


perioperative period, calcium channel blockers (CCBs) are a suitable choice
due to their effectiveness, favorable side effect profile, and minimal impact
on glucose metabolism. Thiazide diuretics, beta-blockers, and ACE inhibitors
may have undesirable effects or complications in the perioperative period,
making them less appropriate for this patient's management. Delaying
treatment until the postoperative period increases the risk of perioperative
cardiovascular complications.

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