Dyspnea inhibitors

A 75-year-old man has inoperable coronary artery disease with an EF of 31%. He is receiving digoxin, furosemide, and an ACE inhibitor. He is unable to walk more than 50 feet on flat ground before getting short of breath (dyspnea on exertion at 50 feet). His heart rate at rest is 85 beats per minute and his blood pressure while seated is 130/85. His neck veins are flat carotid upstrokes are normal lungs are clear and heart examination reveals no murmurs, gallops, or rubs. His extremities reveal no cyanosis, clubbing, or edema. The remainder of the physical examination is unremarkable. What is your next therapeutic option ... 

Indications ACE inhibitors may be considered for single-agent therapy in patients who present with mild dyspnea on exertion and who do not show signs or symptoms of volume overload. ACE inhibitors are useful in decreasing CHF in asymptomatic patients with ejection fraction less than 35% (left ventricular dysfunction). Patients who have had a recent myocardial infarction also benefit from long-term ACE inhibitor therapy. Patients with the lowest ejection fraction show the greatest benefit. Early use of ACE... 

Correct answer = E. ACE inhibitors may be considered sole therapy in patients who present with mild dyspnea on exertion and who do not show signs or symptoms of volume overload. 

SAFETY PROFILE Poison by subcutaneous and intravenous routes. Moderately toxic by intraperitoneal route. Human systemic effects by ingestion dyspnea. An experimental teratogen by many routes. Other experimental reproductive effects. When heated to decomposition it emits ver toxic fumes of NOx and SOx. A carbonic anhydrase inhibitor and diuretic used to treat glaucoma. 

ACUTE HEALTH RISKS irritation of eyes blurred vision dizziness confusion dyspnea (difficult breathing) salivation abdominal cramps nausea vomiting diarrhea cholinesterase inhibitor in animals. 

E. Aromatase Inhibitors Anastrozole and letrozole inhibit aromatase, the enzyme that catalyzes the conversion of androstenedione (an androgenic precursor) to estrone (an estrogenic hormone). Both drugs are used in advanced breast cancer. Toxicity includes nausea, diarrhea, hot flushes, bone and back pain, dyspnea, and peripheral edema. 

Highly toxic by all routes of exposure cholinesterase inhibitor toxic symptoms similar to those of Demeton and range form headache, dizziness, blurred vision, and muscle spasms to gastrointestinal effects manifesting vomiting, diarrhea, and abdominal pain, as well as respiratory symptoms of dyspnea, respiratory depression, and paralysis high exposures may result in onset of seizures and loss of consciousness absorbed readily through skin. 

Toxicology LD50 (oral, rat) 650 pQ/kg, (subcut., rat) 666 pg/kg, (skin, rabbit) 1400 mg/kg powerful systemic poison deadly poison by ing., skin contact, subcut., possibly other routes may be fatal by ing., inh., or skin absorp. absorbed thru skin cholinesterase inhibitor may cause pupillary constriction, nausea, vomiting, diarrhea, muscle twitching, convulsions, anorexia, respiratory failure, weakness, difficulty breathing, abdominal pain, dyspnea, cyanosis, etc. human mutagenic data TSCA listed... 

A teenage boy with focal segmental glomerulosclerosis developed rituximab-associated lung injury associated with progressive dyspnea, fever, hypoxemia, and fatigue 18 days after the completion of a second course of rituximab infusion for calcineurin inhibitor-dependent nephrotic syndrome [150 ]. 

Newer proteasome inhibitors include the orally active peptide boronate MLN9708 and carfilzomib. Adverse reactions to carfilzomib include pulmonary hypertension, dyspnea, infusion reactions, tumor lysis syndrome, hepatotoxicity, rash, and urticaria. 

Of 1471 adult renal transplant recipients, 205 were switched from calcineurin inhibitors to sirolimus (n = 88) or everolimus ( = 117) [29 ]. Six (2.9%) developed pneumonitis, one associated with sirolimus and five with everolimus. Median times from conversion to the onset of pneumonitis were 34 days in four patients (range 24—46 days) and 491 days in 2 subjects (range 454—528 days). The most common symptoms were dry cough ( = 6), fever ( = 5), and dyspnea ( = 4). Imaging tests showed lower lobe involvement in aU cases. Bronchoalveolar lavage in four patients showed ljmiphocj4 ic alveolitis. All recovered completely after drug withdrawal. 

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