When a patient experiences orthostatic light-headedness, which medication should be discontinued?

• A. Ramipril
• B. Atenolol
• C. Lisinopril
• D. Amlodipine

Answer: (B)

In cases of orthostatic light-headedness, the concern typically lies with medications that can lead to hypotension or exacerbate postural changes in blood pressure. Atenolol, a beta-blocker, can impair the compensatory mechanisms that help maintain blood pressure when a patient changes position, particularly in older individuals or those who are already volume depleted. By inhibiting the sympathetic nervous system, beta-blockers can reduce heart rate and contractility, which may worsen symptoms like light-headedness when the patient stands up.

Discontinuing atenolol in such a situation can help reduce the incidence of these symptoms, as stopping the medication allows the autonomic nervous system to function more effectively in maintaining blood pressure stability during postural changes. Other options like Ramipril, Lisinopril, and Amlodipine are also associated with hypotension but have different mechanisms and may not present the same immediate risk regarding orthostatic symptoms as beta-blockers do. Therefore, focusing on the medication that most directly contributes to the issue is vital for managing the patient's symptoms effectively.