Review Question - QID 103676

Hydralazine is an antihypertensive agent sometimes used in the management of hypertension. Hydralazine is associated with drug-induced lupus, which presents with signs and symptoms typical of lupus such as arthralgia and facial rash.

While not fully understood, the mechanism of action of hydralazine is thought to be through smooth muscle relaxation. Many patients exposed to hydralazine will develop drug-induced lupus. Presenting signs and symptoms of drug-induced lupus include fevers, arthralgias, facial rash (malar rash), myalgias, and serositis. Evaluation of suspected drug-induced lupus begins with history and physical exam, as well as laboratory studies to include complete blood counts and antibody screening. Anti-histone antibodies are particularly specific for drug-induced lupus. Management of drug-induced lupus begins with discontinuation of the offending agent. Some patients may require additional pharmacologic management.

Vaglio et. al review drug-induced lupus. They note hydralazine as a common cause, and also outline several additional causes. They discuss the typical clinical presentation specific to associated drugs.

Incorrect Answers:
Answer 2: Cough is a common side effect of ACE inhibitor use as well as hyperkalemia.

Answer 3: Fatigue is a side effect commonly associated with the use of beta-blocker medications. It is not a common side effect associated with the use of hydralazine.

Answer 4: Hyperkalemia is a common side effect of potassium sparing diuretics such as eplerenone or spironolactone.

Answer 5: Hypokalemia is a common side effect associated with use of diuretic medications such as hydrochlorothiazide or furosemide. Hydralazine is not a diuretic medication and is not associated with hypokalemia

Bullet Summary:
Hydralazine is commonly associated with drug-induced lupus, which often presents with symptoms such as arthralgia and facial rash.