Paracetamol has been metabolized

Recovery

You visit Andrew after his liver transplant. The surgery seems to have gone well and Andrew is on track to recovery. 

Andrew seems to be in good spirits, he is happy to be alive. He admits that he had taken a handful of paracetamol tablets, he does not know how many. You try to establish the events that have led to his second suicide attempt. 

Andrew tells you that he was diagnosed with schizophrenia about a year ago. He was started on a medication, he does not remember its name, and things were going well for a while. About two months after he started his medication, he started experiencing some strange side effects. He noticed that his breasts had gotten bigger and they even started to leak a white liquid. He was quite embarassed, he admits, but continued taking his medication. He admits however that he stopped taking his medication, when he started to get these troubling tremors and uncontrolled movements. He continues to explain that he felt that he did not have control of his own body, with uncontrollable muscle contractions of his head, arms and legs. He recognizes now that stopping his medication was a bad idea. He was doing alright in the beginning after stopping his medication but soon enough he became withdrawn, he stopped going out with his friends and even stopped going to university, where he is studying architecture. On the night that he tried to kill himself, he admits that the demons came back. They appeared to be more forceful than he remembers and instructed him to kill himself. Andrew is clearly upset at this point and you decide to leave things here. You thank Andrew for his honesty and encourage him to see his psychiatrist to discuss his medication. 

Considering that you have your prescribing exam coming up, you remember that some anti-emetic drugs can have similar adverse effects to the anti-psychotics (extrapyramidal effects, galactorrhea).

Which anti-emetic drug is most likely to cause these adverse effects? 

Cyclizine
Dexamethasone
Metoclopramide
Ondansetron
Domperidone

Map: Andrew Hall (1102)
Node: 20970
Score:

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OpenLabyrinth
OpenLabyrinth is an open source educational pathway system

Review your pathway

  • B
  • PPIs are weak bases that become activated by colonic bacteria
  • D
  • C
  • Ignore the emotional expression.
  • E
  • A
  • Respond bluntly: “That is common in diabetes.”
  • PPIs are weak acids activated by protonation in parietal cells
  • Blame the patient for non-adherence
  • PPIs are weak bases converted by CYP450 enzymes to the active form in parietal cells
  • Validate the emotion
  • Sequesters bile acids
  • PPIs are weak acids converted by CYP450 enzymes to the active form in parietal cells
  • Reschedule without offering alternative solutions
  • Antagonizes beta receptors
  • Tell the patient to change devices without giving proper guidance.
  • Reschedule with alternative (e.g., WhatsApp call) if needed
  • Insist on continuing with poor video quality
  • Reschedule without offering alternative solutions
  • Switch to audio + chat mode and promise a PDF summary afterward
  • PPIs are weak bases activated by protonation in parietal cells
  • Activates vasopressin receptors
  • Activates somatostatin receptors
  • Reschedule with alternative (e.g., WhatsApp call) if needed
  • Insist on continuing with poor video quality
  • Tell the patient to change devices without giving proper guidance.
  • Ramipril
  • Alters ammonia metabolism by colonic bacteria
  • Metolazone
  • The patient presentation is not due to paracetamol overdose
  • Bisoprolol
  • Cholestasis is the most likely diagnosis
  • There is a risk for a thromboembolic event
  • Amoxicillin
  • Ignore the emotional expression.
  • Validate the emotion
  • Paracetamol has been metabolized

Reminder

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FINISH

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