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Old 08-04-2012
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Drug Which drug is most likely responsible for that reaction?

A 33-year-old woman is being treated with phenelzine for a major depressive disorder. She is brought to the emergency department after sustaining extensive injuries in an automobile accident. She is given several drugs for the treatment of her injuries. Somewhat later, she has a severe reaction consisting of excitation, sweating, rigidity, hypertension, severe respiratory depression, and coma. Which of the following drugs is absolutely contraindicated to give with phenelzine and is most likely responsible for the reaction observed in this patient?

a) Amiodarone
b) Cefazolin
c) Fenoldopam
d) Lorazepam
e) Meperidine

Please give reasoning for your answer
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Old 08-04-2012
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excitation, sweating, rigidity, hypertension-----suggestive of serotonin syndrome
resp depression and coma...opioid effects of meperidine
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Old 08-05-2012
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Ya it's meperidine or pethidine or Demerol ( trade name).
It is related to famous " Libby Zion" case. ( search in wiki. Must read and will help everyone to remember about drug.)


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Old 08-05-2012
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Default correct answer

The answer is e) Meperidine

The issue here was that meperidine's metabolite (normeperidine) is an SSRI.

This patient was being treated with phenelzine, a drug that inhibits monoamine oxidase and increases serotonin levels in the brain. Meperidine, an opioid agonist, should not be used concurrently with monoamine oxidase inhibitors because its metabolite, normeperidine, blocks the neuronal reuptake of serotonin. This can cause the accumulation of serotonin and lead to life-threatening reactions, including excitation, sweating, rigidity, hypertension, severe respiratory depression, coma, and vascular collapse. Likewise, the concurrent use of fluoxetine or another selective serotonin reuptake inhibitor could also cause a serious drug reaction, called the serotonin syndrome, and may include confusion, seizures, and severe hypertension as well as less severe symptoms.
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Old 10-10-2012
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Meperidin is the best choice because of MAO inhibitor and increase the risk of sertonergic syndrome
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Default e) Meperidine

phenelzine (MAOI) + Meperidine produces serotonin syndrome may be due to Meperidine metabolite.
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Old 10-11-2012
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phenelzine(MAOI)+FENOLDOPAM(DOPAMINE AGONIST)>>>>>>HYPERTENSIVE CRISIS...
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Quote:
Originally Posted by rupesh View Post
phenelzine(MAOI)+FENOLDOPAM(DOPAMINE AGONIST)>>>>>>HYPERTENSIVE CRISIS...
Dont think so coz Fenoldopam is used as a drug in HTN Emergency..
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