Question

Tammy, age 27, whose inattention and hyperactivity responded well to a daily dose of 0.2mg of clonidine, comes to see you because she has been put in charge of a huge project at work and is afraid of failing to manage it properly. You agree to increase her clonidine to 0.3mg / day for the time of this project only. A few weeks later she comes back saying that, after successfully completing her project, she went on vacation to relax with her friends and experienced extreme dizziness and drowsiness when they went to the hotel sauna. Additionally, she had forgotten to pack enough clonidine so she had not been taking any for the last couple of days. At her yearly physical yesterday her PCP said that her blood pressure was extremely high. What could have happened? Select one: a. The session in the sauna led to her high blood pressure b. The rapid discontinuation of the medication led to the high blood pressure c. The rapid increase in the medication dose led to the high blood pressure d. High blood pressure can be experienced on vacation as a rebound effect following a high stress period.

Answer 1

Tammy's high blood pressure was caused by the rapid discontinuation of clonidine, a sympatholytic medication used for hypertension and ADHD, leading to a rebound effect of her symptoms.

Step-by-step explanation:

The symptoms described by Tammy after suddenly stopping clonidine, a sympatholytic drug used for hypertension, anxiety, and also for attention deficit hyperactivity disorder (ADHD), are indicative of what is known as withdrawal symptoms or, more precisely in this context, a rebound effect. When an individual ceases to take a medication like clonidine abruptly, the body can experience a rapid return of the symptoms that the medication was treating—in this case, hypertension.

The rapid discontinuation of the medication led to the high blood pressure Tammy experienced. Clonidine suppresses sympathetic outflow, leading to decreased vascular resistance and heart rate, thus lowering blood pressure. When it is suddenly stopped, sympathetic activity can rebound, causing an increase in blood pressure, among other possible withdrawal symptoms such as dizziness and drowsiness.

These effects are not associated with the sauna session, the increased dose of medication before discontinuation, or the recent stress, even though those factors can affect blood pressure individually. The correct answer to Tammy's symptoms is b. The rapid discontinuation of the medication led to the high blood pressure.