Rosh Internal Medicine Boost Practice Exam

Which of the following medications is commonly associated with causing a cough in patients?

1. Clonidine

2. Lisinopril

3. Amlodipine

4. Aspirin

The correct answer is: Lisinopril

The association of cough with the use of certain medications is relevant in clinical practice, particularly with those affecting the renin-angiotensin-aldosterone system. Lisinopril, an ACE (angiotensin-converting enzyme) inhibitor, is well-known for causing a persistent, dry cough in some patients. This side effect arises from the accumulation of bradykinin, a peptide that can lead to cough reflex stimulation when inhibited by ACE. The cough is typically nonproductive and may develop weeks after starting treatment. In contrast, medications like clonidine, amlodipine, and aspirin are not commonly linked to cough as a side effect. Clonidine is an alpha-2 adrenergic agonist primarily used for hypertension management and typically does not provoke cough. Amlodipine, a calcium channel blocker, is more noted for its role in managing hypertension and angina without such respiratory side effects. Aspirin is an anti-inflammatory and antipyretic medication, and while it can cause bronchospasm in asthmatic patients, it is not specifically associated with a common cough in the general population. Therefore, the recognition of lisinopril as a frequent cause of cough is grounded in its mechanisms of action and the patient