DrVirgo
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130. A 42 year old stock broker presents to his physician with complaints of diarrhea adn cutaneous flushing. He notes that these episodes seem to be provoked by stressful events in his work life. An echocardiogram shows evidence of valvular heart disease. Urinalysis shows elevation fo 5-HIAA. Which of the following agents would be most effective in controlling his diarrhea?
A. Bethanechol
B. Bisacodyl
C. Cisapride
D. Cyproheptadine
E. Ondansetron
(What is his diagnosis? Explain your answer and why you chose your drug to treat this patient)
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| robin082006
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Carcinoid syndrome
A?
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| robin082006
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Sorry, D
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| DrVirgo
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Yes. its D
Explanation?
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| surgeon99
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because it is relates to stress
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| DrVirgo
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Yes.
Carcinoid Syndrome.
Cyproheptadine is a 5HT2 Receptor blocker.
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| yasmeen
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D
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| tolito
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D
cyproheptadine, 5HT2 antag counteract the bronchoconstriction, vasodilation and diarrhoea of carcinoid tumors ( which stimulate 5ht2 receptors).
side effect, increased apetitie.
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| gpsbrar
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It is a typical case of Carcinoid tumor with carcinoid syndrome. The best treatment and the only treatment which has great effects is SANDOSTATIN. Give LAR DEPOT form of SANDOSTATIN every month. It is octreotide.
But as there is no other choice, so we would take cyproheptadine coz it is the best available choice. But not in real life though.
Edited by gpsbrar on 04/14/06 - 05:56 PM
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| gpsbrar
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Bethanechol is cholinergic agent. Used clinically for neurogenic atony of urinary bladder
Bisacodyl is laxative and never give to patient with diarrhea.
Cisapride increases GI motility, so can not be given to patient with diarrhea. USED for GERD earlier and now banned in market due to fatal arrythmias.
Cyproheptadine is antihistaminic and antiserotogenic used for allergies. (type 1)
Ondansterone is Nausea and Vomiting in chemo patients.
So technically none of the medications in the choices would help diarrhea though.
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