A 52-year-old woman suffering from hypertension still had a blood pressure of 156/92 mm Hg after 3 months of therapy with hydrochlorothiazide and losartan. Her physician decided to add a third drug that acts by decreasing central sympathetic outflow. Which of the following adverse effects was most likely to occur after a few days of therapy with the new drug?

Correct Answer: A

Rationale: The correct answer is A: Severe postural hypotension. Adding a third drug that decreases central sympathetic outflow (possibly a centrally acting alpha-2 adrenergic agonist) can lead to a sudden drop in blood pressure upon standing, causing postural hypotension. This occurs due to decreased sympathetic tone leading to vasodilation and reduced vascular tone. This effect is more likely to occur shortly after initiating therapy with the new drug. Choice B: Megaloblastic anemia is not a common adverse effect of drugs that decrease sympathetic outflow. Choice C: Palpitations are not typically associated with drugs that decrease sympathetic outflow. Choice D: Pronounced sedation is not a common side effect of centrally acting sympatholytic drugs.

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: C

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.