A 52-year-old woman with hypertension initiated on lisinopril presents 2 weeks later with a persistent dry cough. Vital signs show BP 128/82 mmHg, HR 76/min, RR 18/min, and normal temperature. Laboratory studies reveal hyperkalemia (K+ 5.8 mEq/L) and normal renal function. She denies dyspnea, orthopnea, or recent infections. The cough is most likely due to which of the following mechanisms?
- A)Direct bronchial irritation from drug crystallization
- B)ACE inhibition decreasing bradykinin metabolismGABARITO
- C)Reflex cough from sudden blood pressure reduction
- D)Pulmonary edema from hyperkalemia-induced cardiac dysfunction
- E)Increased airway reactivity from angiotensin II deficiency
Explicação
ACE inhibitors block the conversion of angiotensin I to angiotensin II, but they also inhibit degradation of bradykinin. Bradykinin accumulation stimulates vagal sensory C-fibers in the airways, triggering a persistent dry cough. This occurs in ~10-20% of ACE ... Ver explicação completa e trilha adaptativa →