How does propranolol (Inderal), a beta blocker medication, control hypertension?

Choice A reason: This is not the cause of pulmonary symptoms in left heart failure. Decreased cardiac output is a consequence of left heart failure, which affects the perfusion of vital organs and tissues.

Choice B reason: This is not the cause of pulmonary symptoms in left heart failure. Bronchoconstriction is a feature of asthma and chronic obstructive pulmonary disease (COPD), which affect the airways and cause wheezes and shortness of breath.

Choice C reason: This is not the cause of pulmonary symptoms in left heart failure. Inflammatory pulmonary edema is a type of non-cardiogenic pulmonary edema, which occurs when the alveolar-capillary membrane is damaged by an inflammatory process, such as pneumonia or sepsis.

Choice D reason: This is the correct cause of pulmonary symptoms in left heart failure. Pulmonary vascular congestion is a result of increased pressure in the pulmonary circulation, which occurs when the left ventricle fails to pump blood effectively to the aorta and the rest of the body. This causes fluid to leak into the alveoli and interstitial spaces, leading to cough, dyspnea, crackles, and pink frothy sputum.

Choice A reason: This is not a correct statement. LABAs stand for long-acting beta2-agonists, which are a class of medications that relax the smooth muscles of the airways and improve the airflow in patients with asthma or COPD. However, LABAs do not reduce the risk of asthma-related deaths, and may even increase it if used alone without an inhaled glucocorticoid, which is a type of anti-inflammatory medication.

Choice B reason: This is not a correct statement. LABAs cannot be used on an as-needed basis to treat symptoms, as they have a slow onset of action and a long duration of effect. LABAs are meant to be used as a maintenance therapy to prevent asthma exacerbations, not to relieve acute symptoms. For quick relief of symptoms, patients should use a short-acting beta2-agonist, such as albuterol or salbutamol.

Choice C reason: This is not a correct statement. LABAs are not safer than short-acting beta2 agonists, as they have similar side effects, such as tachycardia, tremors, and hypokalemia. LABAs also have a black box warning that they may increase the risk of asthma-related deaths if used without an inhaled glucocorticoid.

Choice D reason: This is the correct statement. LABAs should be combined with an inhaled glucocorticoid, as this combination has been shown to improve the asthma control, reduce the frequency and severity of exacerbations, and decrease the inflammation and airway hyperresponsiveness. The inhaled glucocorticoid also reduces the risk of adverse effects and mortality associated with LABAs.