Angioedema: The Daily PANCE Blueprint

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Angioedema: The Daily PANCE Blueprint

A 65-year-old man comes to the emergency department complaining of swelling around his eyes and lips that started earlier in the day. He has a history of hypertension, hyperlipidemia, and type 2 diabetes. He recently had his medications adjusted by his primary care provider, including the addition of a new blood pressure medication. He denies any difficulty breathing, swallowing, or rash. On examination, there is non-tender swelling of the periorbital area and lips. His vital signs are stable, and there is no tongue or throat involvement. Which medication is most likely responsible for these symptoms?

A. Increasing the dose of metformin
B. Replacing metoprolol with lisinopril
C. Adding atorvastatin to his regimen
D. Switching tamsulosin to doxazosin
E. Starting indomethacin for joint pain

Answer and topic summary

The answer is B. Replacing metoprolol with lisinopril

Lisinopril, an ACE inhibitor, is a common cause of angioedema, which typically manifests as non-pitting swelling of the lips, face, and eyelids. Angioedema due to ACE inhibitors occurs as a result of increased bradykinin levels, leading to vasodilation and fluid accumulation. The absence of respiratory distress or rash helps distinguish it from an allergic reaction. The patient’s recent switch from losartan (an angiotensin II receptor blocker, or ARB) to lisinopril makes the ACE inhibitor the most likely cause. Management includes immediate discontinuation of the ACE inhibitor, with other blood pressure management strategies needed.

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Covered under ⇒ PANCE Blueprint EENT ⇒ Oropharyngeal disorder ⇒ Angioedema

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