A 73-year-old man complained to his physician of increasing fatigue and shortness of breath that was often worse at night, forcing him to “sit bolt upright.” He also noticed that his feet were getting swollen. Past history was unremarkable. Vital signs were blood pressure 150/90, respirations 17/min. On examination, mild pitting edema was seen on the legs. An electrocardiogram disclosed a second-degree atrioventricular block. His physician diagnosed initial cardiac failure and prescribed an appropriate therapy. Which of the following drugs would be contraindicated for this patient?
ExplanationDigoxin is relatively contraindicated in patients with significant atrioventricular (AV) block because the drug decreases AV conduction via both parasympathomimetic actions and a direct depressive effect on the AV node. Moreover, digoxin is not indicated for mild cardiac failure. Because the patient is hypertensive, all the other listed drugs are appropriate for initial heart failure or for hypertension.