Registered Cardiovascular Invasive Specialist (RCIS) Practice Test

If a patient presents with elevated creatinine and decreased GFR, which medication should be avoided?

1. Lasix

2. ACE inhibitors

3. Beta blockers

4. Calcium channel blockers

The correct answer is: Lasix

In a patient presenting with elevated creatinine and decreased glomerular filtration rate (GFR), the medication that should be avoided is Lasix, which is a loop diuretic. The reasoning for avoiding Lasix in this scenario primarily stems from the potential impact on renal function and fluid balance. Loop diuretics like Lasix can cause increased diuresis, which may lead to dehydration and further compromise renal perfusion, especially in patients who already have impaired kidney function. With elevated creatinine levels and decreased GFR, the kidneys are not filtering waste effectively, and the use of a diuretic might exacerbate the situation by causing volume depletion. This situation could further elevate serum creatinine levels, worsening the patient's renal status. In contrast, ACE inhibitors, while they may affect renal hemodynamics temporarily, are often used with caution in patients with decreased GFR but may be beneficial in certain populations (e.g., those with heart failure or diabetic nephropathy) by providing long-term renal protection. Beta blockers and calcium channel blockers generally do not have the same immediate negative impact on renal function and may actually be beneficial in managing other cardiovascular conditions. Therefore, Lasix should be avoided in this specific scenario to prevent further worsening of kidney function and