A 67-Year-Old Woman Is Evaluated for Intermittent Claudication Prior to Angiography

question 854

Multiple Choice

A 67-year-old woman is evaluated for intermittent claudication prior to angiography.  At a recent evaluation, her ankle-brachial index was 0.65 on the right and 0.75 on the left.  The patient has a history of long-term cigarette smoking, hypertension, type 2 diabetes mellitus, hyperlipidemia, and severe degenerative arthritis of the knees.  Current medications include simvastatin, ibuprofen, glipizide, and amlodipine.
Blood pressure is 130/86 mm Hg and pulse is 72/min.  Cardiac examination reveals a grade 2/6 systolic ejection murmur at the base.  The lungs are clear and there is no jugular venous distension.  Tibial pulses are 1+ and the patient has trace pedal edema of the ankles bilaterally.
Serum creatinine is 2 mg/dL and urinalysis shows 2+ proteinuria.
In addition to using the smallest dose of a third-generation contrast agent and prehydrating with normal saline, which of the following is the most appropriate precaution for this patient's angiography?

• A)Discontinuation of ibuprofen
• B)Furosemide during and following the procedure
• C)Intravenous dopamine during the procedure
• D)Mannitol prior to and during the procedure
• E)Prophylactic hemofiltration

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