yash12
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A 51-year-old diabetic woman, who is being treated with chemotherapy after surgery for breast cancer, presents at the emergency department of the local hospital. She had just started taking metaprolol for hypertension and prochlorperazine for nausea the day before. She is brought in by her husband because she has been acting bizarrely over the past 24 hours, feeling a little low,insomnia, drowsiness with waxy flexibility in her movements and mutism. Her physical examination and vital signs are within normal limits. Which of the following is the most appropriate pharmacotherapy?
A. Alprazolam
B. Benztropine
C. Haloperidol
D. Methylphenidate
E. Flumazenil
F. Diazepam
G. Glucose
H. Valproic acid
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| prasannakumar
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glucose
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| dr in trouble
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B--Benztropine
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| yash12
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??
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| ssrpk
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just a hunch, shes a diabetic woman and hypoglycemic episodes can occur but the symptom would be masked resulting in neurologic symptoms like these, so wtih that respect, should be glucose....its a far fetched idea, but i cant make much sense to it
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| usmlestud
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interaction btn metoprolol& prochloperazine..agree with B
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| yash12
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Can you please explain this " Interaction between Metoprolol and Prochloperazine" !!
and why - Benztropine !!!!
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| usmlestud
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prochlorperazine can cause parkinson like side effects esp. when used in pts older than 60.treatment is with antiparkinson drugs.i know that there is an interaction with concurrent use of beta blockers...donno how
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| cirus
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so prochlorperazine acts like metacloprmide?
I know metaclopramide causes parkinsonism, but i never heard about prochlorperazine..
can u plz tell me where to read this
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| usmlestud
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i never knew it until i read this q and "googled" for an answer..
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| ssrpk
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yeah maybe prochlorperazine can cause parkisononian symptoms, why not atleast it belong to the same group of drugs which do....but more important question is "IS THIS PATIENT HAVING PARKINSONS LIKE MOVEMENT SYMPTOMS"
certainly insomnia or drowsiness or feeling low is not typical of parkinsons.
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| usmlestud
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she has extrapyramidal symptoms, not pakinsonism pre se
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| yash12
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OK, so "B" Benztropine is the answer.
Why, because Prochlorperazine is frequently used to treat nausea and emesis in patients. Side effects of this medication, including extrapyramidal reactions (e.g., catatonia), are treated best by antiparkinsonian medications such as benztropine.
Good work usmlestud and dr in trouble !
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| dr in trouble
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thanx yush12--good Q
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| Hotobhaga
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I have personally seen and treated a number of patients with EPS following Prochlorperazine
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| ssrpk
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oh catatonia....good q
it seems like among the other meds antipsuchotics and antidepressants are very much high yield, not just the group as a whole but the individual drugs as well.
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| dr19
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catatonic stupor.......good question
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| dr19
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by the way,does she have extrapyramidal syndrome
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| dr19
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By the way,does she have extrapyramidal syndrome
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| ssrpk
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hey yash12 can yiou proviode some references, the website i checked says otherwise, and btw is catatonia a part of extrapyramidal symptoms???
check out this website:
http://www.answers.com/topic/catatonia?cat=health
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| yash12
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Hello , ssrpk
To start with, look for a dectionary defination of Catatonia and you would find this :
Catatonia is a condition that includes symptoms such as catalepsy, stupor, rigidity, posturing, and waxy flexibility .
Now you interpret this information and think if it is in EPS
Now, regarding this patient as he is on Prochlorperazine , we are expected to know every single little detail of all the med. used for depression and psychosis - as you have mentioned above  ,
So now Prochlorperazine side effects :
drowsiness and /or
jaw, neck, and back muscle spasms
fine worm-like tongue movements
rhythmic face, mouth, or jaw movements
slow or difficult speech
difficulty swallowing
restlessness and pacing
tremors
shuffling walk
skin rash
yellowing of the skin or eyes
and we know that if any of the symptom is present in the patient taking Prochlor. , they are treated best by antiparkinsonian medications such as benztropine.
Above explanation is just to make thinghs clear point by point, hope this helps !!
Cheers
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| ssrpk
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okay, so you are saying, that on one hand its catatonia, for which benzodiazepines are preferred treatment, but just because its prochlorperazine we are gonna use antimuscarinic..... still don't make sense to me.
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| elitoki
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Good Q and very detailed explanation! Thanks yash12!!
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