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  #1  
Old 11-24-2012
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Default Medicine Q ?

A 60-year-old man comes to the physician because of difficulty sleeping and concentrating and a 5-kg (10-lb) weight loss over the past 3 months. He also has become withdrawn. He has had chronic pain since sustaining fractures of the left lower extremity,pelvis, and several ribs in a motor vehicle collision 2 years ago. He has a previous history of alcohol abuse. He takes a nonsteroidal
anti-inflammatory drug. Which of the following is the most appropriate
pharmacotherapy?

A
) Carbamazepine

B
) Chlordiazepoxide

C
) Disulfiram

D
) Lithium carbonate

E
) Nortriptyline
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Old 11-24-2012
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Nortriptyline for chronic pain +depression
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Old 11-24-2012
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Quote:
Originally Posted by Novobiocin View Post
Nortriptyline for chronic pain +depression
Yes true.

But I got it wrong because I was thinking an elderly man,so we should not give TCA.
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Old 11-24-2012
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Quote:
Originally Posted by aknz View Post
Yes true.

But I got it wrong because I was thinking an elderly man,so we should not give TCA.
In that case they will give BPH in the question stem.
Even without that there are no other antidepressants among the choices.
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Old 11-24-2012
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option E............also nortryptyline has fewer anticholinergic SE's compared to 3rd generation TCA's like amitryptyline...hence preferred in elderly.....
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Old 11-25-2012
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Quote:
Originally Posted by aknz View Post
A 60-year-old man comes to the physician because of difficulty sleeping and concentrating and a 5-kg (10-lb) weight loss over the past 3 months. He also has become withdrawn. He has had chronic pain since sustaining fractures of the left lower extremity,pelvis, and several ribs in a motor vehicle collision 2 years ago. He has a previous history of alcohol abuse. He takes a nonsteroidal
anti-inflammatory drug. Which of the following is the most appropriate
pharmacotherapy?

A
) Carbamazepine

B
) Chlordiazepoxide

C
) Disulfiram

D
) Lithium carbonate

E
) Nortriptyline
i think it should be nortriptyline. coz of depression with pain.
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Old 11-26-2012
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E ) Nortriptyline
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