Question

A man with a history of poor dental hygiene and high blood pressure complains of tender and swollen gums during an appointment with his dentist. Which antihypertensive drug might be contributing to this condition? (A) irbesartan (B) metoprolol (C) nifedipine (D) hydrochlorothiazide (E) doxazosin

Short answer

The antihypertensive drug likely causing swollen gums is nifedipine.

Step-by-step solution

Understanding the Problem

The exercise involves connecting a physical condition, tender and swollen gums, to the possible side effect of an antihypertensive drug used by a patient. The key phrase is 'tender and swollen gums.' This suggests the condition is gingival hyperplasia, which is known to be a side effect of certain medications.

Identifying Drug Side Effects

Recognize that gingival hyperplasia (gum swelling) is a well-known side effect of some calcium channel blockers and anticonvulsant drugs. Among the options, 'nifedipine' stands out as it is a calcium channel blocker, and can cause gum swelling and tenderness.

Eliminating Other Options

Review the side effects of other drugs: - (A) Irbesartan: Typically causes dizziness, fatigue, sometimes hyperkalemia, but not gum issues. - (B) Metoprolol: Commonly used beta-blocker, has side effects like fatigue and dizziness. - (D) Hydrochlorothiazide: A diuretic, may cause electrolyte imbalance, not gum issues. - (E) Doxazosin: An alpha-blocker, can cause dizziness and fatigue, not gum issues.

Concluding the Solution

With nifedipine clearly causing gingival hyperplasia, while the other options do not relate to gum swelling, the most likely contributor to tender and swollen gums related to medication is nifedipine.

Key concepts

Antihypertensive Drugs

Medications prescribed to manage high blood pressure are known as antihypertensive drugs. These drugs play a crucial role in controlling blood pressure to prevent complications such as strokes, heart attacks, and kidney problems.
Managing hypertension often involves using a combination of different types of drugs due to their unique mechanisms of action. These medications work by relaxing blood vessels, reducing heart rate, or altering blood volume.

• Calcium channel blockers
• Beta-blockers
• Diuretics
• ACE inhibitors
• Angiotensin II receptor blockers (ARBs)

Each class has specific benefits and potential side effects, which influence the choice of drug by healthcare providers tailoring treatment to individual patient needs.

Side Effects

Every medication, including antihypertensive drugs, can cause side effects. While many side effects are mild and temporary, others can be more severe and require medical attention.
Understanding side effects is crucial for patients to recognize potential issues early and report them to their healthcare provider. This enables appropriate management or switching to a different medication if necessary.
Common side effects of antihypertensive drugs include:

• Dizziness or lightheadedness
• Fatigue
• Electrolyte imbalances
• Headaches

Sometimes, drugs may also cause less common side effects, like gingival hyperplasia, especially linked with medications such as certain calcium channel blockers.

Gingival Hyperplasia

Gingival hyperplasia refers to the abnormal overgrowth of gum tissue, leading to tender and swollen gums. This condition can result from various causes, including poor dental hygiene, hormonal changes, and certain medications.
Antihypertensive drugs, specifically some calcium channel blockers like nifedipine, can cause this side effect. It manifests as gum swelling, tenderness, and overgrowth that may complicate oral hygiene.
Patients experiencing gingival hyperplasia should conduct regular dental checkups, maintain proper oral hygiene, and discuss potential medication changes with their healthcare providers if the condition affects their quality of life.

Calcium Channel Blockers

Calcium channel blockers are a class of antihypertensive drug that works by inhibiting calcium from entering the cells of the heart and blood vessel walls, relaxing the blood vessels, and reducing blood pressure.
These drugs are effective for treating various cardiovascular conditions, including high blood pressure and angina. Nifedipine, a common calcium channel blocker, is often prescribed for its efficacy.
Despite their effectiveness, these drugs are associated with certain side effects like dizziness, headaches, and gingival hyperplasia. If patients notice gum swelling, they should consult with their healthcare provider to assess whether a change in medication is necessary. Understanding the balance between benefits and potential side effects is crucial for effective and safe treatment.