HTN patient, recurrent falls

Medical case consultation
#1

A 57yo woman who is suffering from HTN, presented to the hospital with complaints of
recurrent falls when trying to get out of bed or getting up from sitting. She is on some anti-HTN
therapy with no other med prbs. What is the cause of her fall?
a. CCB
b. Vestibrobasiliar insufficiency
c. Thiazide
d. Hypoglycemia
e. Infection

answer: C

Drug induced orthostatic hypotension

I. Causes: Cardiac Medications

  •    Methyldopa

  •    Clonidine

  •    Alpha adrenergic blockers (e.g. Prazosin, Doxazosin, Terazosin)

  •    Beta Blockers (e.g. Atenolol)

  •    Alpha-Beta Blockers (Carvedilol, Labetalol)

  •    Vasodilator medications
 Nitrates (Nitroglycerin)

Calcium Channel Blockers
ACE Inhibitors (e.g. Lisinopril)
Hydralazine
Dipyridamole (Persantine)
Reserpine

  •    Diuretics (e.g. Furosemide, Thiazide)

  •    Quinidine

II. Causes: Genitourinary Medications

Phosphodiesterase type 5 inhibitors (e.g. Sildenafil or Viagra)
Anticholinergics (e.g. Oxybutynin or Ditropan)

III. Causes: Neuropsychiatric Agents

Parkinsonism agents (Levodopa-Carbidopa, Bromocriptine)
Barbiturates
MAO inhibitors (e.g. Phenelzine)
Tricyclic Antidepressants (e.g. Amitriptyline, Doxepin, Trazodone)
Antipsychotics (e.g. Chlorpromazine, Clozapine, thioridazine)
Muscle relaxants (e.g. Baclofen, Cyclobenzaprine, Methocarbamol, Tizanidine)

IV. Causes: Miscellaneous

Opioids (e.g. Morphine)
Vincristine
Insulin