A 42 year-old African American female visits your office for an annual checkup appointment. The patient has a history of hypertension refractory to thiazide diuretics and angiotensin converting enzyme (ACE) inhibitors. Blood pressure is 170/115 mmHg and BMI is 31 m/kg2. You write a prescription for hydralazine. You instruct the patient to call your office is she experiences which of the following drug-related side effects:
1.Cough
2.Angioedema
3.Maculopapular facial rash
4.Seizure
5.Weight loss
exp:
Hydralazine is a commonly used agent in the management of patients with severe hypertension, often defined as a blood pressure above 160/110 mmHg. A maculopapular facial rash can be seen with this therapy.
Hydralazine is one of several drugs associated with drug-induced lupus syndrome, the symptoms of which include flu-like symptoms, myalgias, arthralgias, fever, and maculopapular facial rash. Patients on hydralazine who develop symptoms of drug-induced lupus syndrome should stop the medication immediately. Anti-histone antibodies are an important immunological marker of drug-induced lupus syndrome.
Illustration A shows common causes of drug-induced lupus.
Illustration B shows malar rash typical of lupus, including drug-induced lupus.