OSMOSIS PREGUNTAS Flashcards
A 55-year-old patient with
Parkinson’s disease is brought into your emergency department by his son with a change in mental status. His
current medications
include
levodopa
/carbidopa and
rosuvastatin
. He presents confused and agitated. During your exam, he begins shouting and throwing objects in his room. Which of the following medications is the best selection for this patient to calm him down at this time?
IM
lorazepam
This is the best option in this patient. Intramuscular route medications are best for acute agitation, and
benzodiazepines
are not associated with worsening
Parkinsonian symptoms
.
Haloperidol
is commonly used in acutely agitated patients; however, it is important to remember
that it is contraindicated in patients with Parkinson’s Disease
. Benzodiazepines
or the antipsychotics quetiapine
or clozapine
(which are sedating in nature) are better selections in these patients.
A 40-year-old man is brought to the clinic because of sudden repetitive painless tongue movements and excessive eye blinking for the past 3 days. Patient’s wife says that he also has been experiencing grimacing and lip smacking and puckering in a “weird” way. Medical history is contributory for hypertension and schizophrenia. Patient has been taking metoprolol for the past 5 years and olanzapine for the past 20 years. His temperature is 37.8°C (100°F), pulse is 65/min, respirations are 18/min, and blood pressure is 127/81 mm Hg. Which of the following is the most likely diagnosis?
Tardive dyskinesia
Tardive dyskinesia (TD) is a difficult-to-treat and often incurable form of dyskinesia, a disorder resulting in involuntary
, repetitive body movements. Involuntary
movements are tardive, meaning they have a slow or belated onset. This neurological disorder occurs as the result of long-term (usually at least 3 months duration) or high-dose use of antipsychotic drugs, or in children and infants as a side effect from usage of drugs for gastrointestinal disorders, typically metaclopramide
. First generation antipsychotics
such as fluphenazine
, haloperidol
, and pimozide are particularly implicated.
TD is characterized by repetitive and involuntary
movements (e.g. grimacing, tongue
movements, lip smacking, lip puckering, pursing of the lips
, and excessive eye
blinking). The exact mechanism of the disorder remains largely uncertain. The most compelling line of evidence suggests that TD result primarily from neuroleptic-induced dopamine
super sensitivity
in the nigrostriatal pathway, with the D2 dopamine
receptor being most affected. Currently, there are no FDA approved drugs for treating TD, though some have shown efficacy in studies like tetrabenazine
, reserpine
, ondansetron
, clonidine
, Botox injections, and benzodiazepines
, among others. TD most commonly occurs in patients with psychiatric conditions
who are treated with antipsychotic medications for many years. The average prevalence rate
has been estimated to be around 30% for individuals taking antipsychotic medication.
A 40-year-old man is brought to the clinic because of sudden repetitive painless tongue movements and excessive eye blinking for the past 3 days. Patient’s wife says that he also has been experiencing grimacing and lip smacking and puckering in a “weird” way. Medical history is contributory for hypertension and schizophrenia. Patient has been taking metoprolol for the past 5 years and olanzapine for the past 20 years. His temperature is 37.8°C (100°F), pulse is 65/min, respirations are 18/min, and blood pressure is 127/81 mm Hg. Which of the following is the most likely diagnosis?
Tardive dyskinesia
Tardive dyskinesia (TD) is a difficult-to-treat and often incurable form of dyskinesia, a disorder resulting in involuntary
, repetitive body movements. Involuntary
movements are tardive, meaning they have a slow or belated onset. This neurological disorder occurs as the result of long-term (usually at least 3 months duration) or high-dose use of antipsychotic drugs, or in children and infants as a side effect from usage of drugs for gastrointestinal disorders, typically metaclopramide
. First generation antipsychotics
such as fluphenazine
, haloperidol
, and pimozide are particularly implicated.
TD is characterized by repetitive and involuntary
movements (e.g. grimacing, tongue
movements, lip smacking, lip puckering, pursing of the lips
, and excessive eye
blinking). The exact mechanism of the disorder remains largely uncertain. The most compelling line of evidence suggests that TD result primarily from neuroleptic-induced dopamine
super sensitivity
in the nigrostriatal pathway, with the D2 dopamine
receptor being most affected. Currently, there are no FDA approved drugs for treating TD, though some have shown efficacy in studies like tetrabenazine
, reserpine
, ondansetron
, clonidine
, Botox injections, and benzodiazepines
, among others. TD most commonly occurs in patients with psychiatric conditions
who are treated with antipsychotic medications for many years. The average prevalence rate
has been estimated to be around 30% for individuals taking antipsychotic medication.
A 22-year-old man is admitted to inpatient psychiatry after an attempt to strangle a stranger on the street in order to “squeeze the demons out” at the command of a voice in his head. He was put on a standing dose of haloperidol. Which of the following long-term adverse effects can be attributed to haloperidol?
Tardive dyskinesia
A 28-year-old woman is diagnosed with bipolar disorder after being brought to the ED for a manic episode. She has a positive pregnancy test and says that she’s surprised to find out she is pregnant because she hasn’t yet missed her period. Which of the following is the best medical management for her acute manic episode?
Haloperidol
In the first trimester
, Haloperidol
is the drug of choice for acute mania
.
Main explanation
In the first trimester
, Haloperidol
is the drug of choice for acute mania
- Lamotrigine
is used for maintenance therapy in all the 3 trimesters
. The other choices are all known teratogens (Lithium
- Ebstein’s abnormality and renal problems
, Valproic acid
and Carbamazepine
- CNS
defects).
A 28-year-old woman is diagnosed with bipolar disorder after being brought to the ED for a manic episode. She has a positive pregnancy test and says that she’s surprised to find out she is pregnant because she hasn’t yet missed her period. Which of the following is the best medical management for her acute manic episode?
Haloperidol
In the first trimester
, Haloperidol
is the drug of choice for acute mania
.
Main explanation
In the first trimester
, Haloperidol
is the drug of choice for acute mania
- Lamotrigine
is used for maintenance therapy in all the 3 trimesters
. The other choices are all known teratogens (Lithium
- Ebstein’s abnormality and renal problems
, Valproic acid
and Carbamazepine
- CNS
defects).
A 33-year-old woman with intractable hiccups is in severe discomfort in the emergency department. Attempts to extinguish the hiccups have included holding her breath, bearing down, sipping ice water, gargling the same water, swallowing a sugar cube, pressing on her closed eyes, getting into the fetal position, and leaning forward, all to no avail. What can be given to arrest the hiccups?
Chlorpromazine
Major takeaway
If physical maneuvers fail and there is no clear etiology for the hiccups
within another disease or condition, then Chlorpromazine
should be considered the first line treatment for intractable hiccups
.
Main explanation
By a mechanism not well understood and in a series of small case series, antipsychotics have demonstrated success in treating intractable hiccups
. Chlorpromazine
, alone among this class of drugs, is approved by the FDA for this clinical use. If physical maneuvers fail and there is no clear etiology for the hiccups
within another disease or condition, then Chlorpromazine
should be considered the first line treatment for intractable hiccups
. There is some evidence from studies that the dopamine
antagonist metoclopramide
and skeletal muscle
relaxant baclofen
can be effective as a second line therapies for intractable hiccups
. There is some evidence from studies that anticonvulsants, antidepressants
, CNS
stimulants, antiarrythmics, nefopam, marijuana
, and amantadine
can be effective as third line therapies for intractable hiccups
.
A 33-year-old woman with intractable hiccups is in severe discomfort in the emergency department. Attempts to extinguish the hiccups have included holding her breath, bearing down, sipping ice water, gargling the same water, swallowing a sugar cube, pressing on her closed eyes, getting into the fetal position, and leaning forward, all to no avail. What can be given to arrest the hiccups?
Chlorpromazine
Major takeaway
If physical maneuvers fail and there is no clear etiology for the hiccups
within another disease or condition, then Chlorpromazine
should be considered the first line treatment for intractable hiccups
.
Main explanation
By a mechanism not well understood and in a series of small case series, antipsychotics have demonstrated success in treating intractable hiccups
. Chlorpromazine
, alone among this class of drugs, is approved by the FDA for this clinical use. If physical maneuvers fail and there is no clear etiology for the hiccups
within another disease or condition, then Chlorpromazine
should be considered the first line treatment for intractable hiccups
. There is some evidence from studies that the dopamine
antagonist metoclopramide
and skeletal muscle
relaxant baclofen
can be effective as a second line therapies for intractable hiccups
. There is some evidence from studies that anticonvulsants, antidepressants
, CNS
stimulants, antiarrythmics, nefopam, marijuana
, and amantadine
can be effective as third line therapies for intractable hiccups
.
