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 He was doing alright in the beginning after stopping his medication but soon enough he became withdrawn, he stopped going out with his friends and even stopped going to university, where he is studying architecture.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? 

Domperidone
Ondansetron
Dexamethasone
Metoclopramide
Cyclizine

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

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  • Jonás tiene 30 años y vive con su madre en Salónica.
  • Celecoxib
  • Aluminum hydroxide and Magnesium carbonate
  • Ζητάτε από τον γενικό γιατρό να κάνει επαναληπτική εξέταση
  • Inhalational fluticasone (glucocorticoid)
  • Nebulized ipratropium (SAMA, anticholinergic)
  • Delegate explanation to another profession
  • Intravenous resluzimab (IL-5 antibody)
  • Paracetamol has been metabolized

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