American Board of Internal Medicine (ABIM) Certification Practice Exam

Which medication class is recommended for managing Raynaud phenomenon in MCTD patients?

1. PPI

2. Calcium Channel Blockers

3. Glucocorticoids

4. Methotrexate

The correct answer is: Calcium Channel Blockers

Calcium channel blockers are recommended for managing Raynaud phenomenon in patients with mixed connective tissue disease (MCTD) because they effectively promote vasodilation and enhance blood flow to the digits during episodes of reduced blood supply. Raynaud phenomenon is characterized by episodic vasospasm in the small arteries of the fingers and toes, leading to discoloration, pain, and discomfort. By blocking the influx of calcium into vascular smooth muscle cells, these medications help relax the muscle and prevent constriction, significantly alleviating symptoms associated with the condition. While other classes of medications have their roles in treating various aspects of MCTD, they do not target the specific vascular mechanism responsible for Raynaud phenomenon as effectively as calcium channel blockers do. For instance, proton pump inhibitors (PPIs) are primarily used for managing gastric acid-related disorders and have no direct impact on vascular function. Glucocorticoids are anti-inflammatory agents that may address systemic inflammation but are not the first line of treatment for Raynaud's specifically. Similarly, methotrexate is often employed as a disease-modifying antirheumatic drug for managing autoimmune conditions but does not have a direct vasodilatory effect. Therefore, the use of calcium channel blockers is well-supported in this context