cardiology2016 ppt课件.pptxVIP

cardiology2016 241-250Q 1A 65-year-old immigrant from Eastern Europe comes to the physician because of a four-week history of low-grade fever multiple joint pains, and a well-demarcated erythematous rash on his face and trunk. The patient denies hair loss, mucosal ulceration, or photosensitivity. His serum test is positive for the presence of antinuclear antibody (ANA) in very high titers. The patient reports a past medical history of coronary artery disease, congestive heart failure, and cardiac rhythm abnormalities.This patient should be specifically questioned about the intake of which of the following medications?A. Amiodarone B. Propranolol C. Lidocaine D. Procainamide E. Verapamil O F. AdenosineA 1 Correct answer:DFeatures of drug-induced lupus erythematosus New onset lupus symptomsAnti-nuclear antibodies (ANA) and antihistone antibodies present in 95% of casesAnti-dsDNA antibodies are rarely seenExposure to implicated drugsHydralazine Procainamide IsoniazidMinocycline QuinidineDrug-induced lupus erythematosus (DILE) should be considered in patients presenting with signs and symptoms of systemic lupus erythematosus (SLE). Both hydralazine and procainamide are categorized as high-risk drugs for the development of DILE. Procainamide is metabolized via hepatic acetylation. Individuals who are “slow acetylators” are at greatest risk for DILE. while individuals who metabolize the drug more rapidly are less likely to experience this adverse effect. Drug-induced lupus erythematosus occurs in up to 20% of patients taking procainamide.The presence of autoantibodies can be used to help differentiate DILE from SLE. Although anti-histone antibodies are very common in DILE, they are seen in only 50% of SLE patients. Likewise. anti-dsDNA antibodies are present in 80% of SLE patients, but are rarely seen in DILE. Anti-nuclear antibodies are frequently positive in both diseases.(Choice A) The most notable side effects of amiodarone include thyroid dysfunction, lung fibrosi