[step1an]

A 54 yr old man is hospitalized after a planned abdominal surgery. One of his physicians administers a new drug whose mechanism of action you do not know. Shortly after administration, the pt develops flushing, daiphoresis & nausea. His blood pressure is 100/70 mm Hg & heart rate is 55/ min. His pupils are constricted but reactive to light. The medication is most likely given for which of the following conditions?

• A. Fluid overload
• B. UTI
• C. Urinary obstruction
• D. Hypovolemic shock
• E. Atonic Bladder

 

[doctorF]

B-- UTI.... disulfiram lyk effect of cephalosporin???:notsure: or may be epineprine for hypovolemic shock...D... bt epinephrine is given for anaphylactic shock... emm confused :sorry:!!!

 

[step1an]

B-- UTI.... disulfiram lyk effect of cephalosporin???:notsure: or may be epineprine for hypovolemic shock...D... bt epinephrine is given for anaphylactic shock... emm confused :sorry:!!!

A clue !!! you are missing the eye changes....

 

[just_md]

Good questions

It is Bethanechol given to treat urinary retention after operation.
So it has to be choice E.

Side effects of Bethanechol:
Body as a Whole: malaise;
Digestive: abdominal cramps or discomfort, colicky pain, nausea and belching, diarrhea, borborygmi, salivation;
Renal: urinary urgency;
Nervous System: headache;
Cardiovascular: a fall in blood pressure with reflex tachycardia, vasomotor response;
Skin: flushing producing a feeling of warmth, sensation of heat about the face, sweating;
Respiratory: bronchial constriction, asthmatic attacks;
Special Senses: lacrimation, miosis.

We have low BP, tachy may be later

Contraindicated in urinary obstruction

Thanks!

​

 

[doctorF]

NYCE question!!! thanks for highlighting that bethanecol causes skin flushing as well... i never thought abt it bks flushing gave me a thot abt atropine and it causes mydriasis....:toosad:

 

[step1an]

It is Bethanechol given to treat urinary retention after operation.
So it has to be choice E.

Side effects of Bethanechol:
Body as a Whole: malaise;
Digestive: abdominal cramps or discomfort, colicky pain, nausea and belching, diarrhea, borborygmi, salivation;
Renal: urinary urgency;
Nervous System: headache;
Cardiovascular: a fall in blood pressure with reflex tachycardia, vasomotor response;
Skin: flushing producing a feeling of warmth, sensation of heat about the face, sweating;
Respiratory: bronchial constriction, asthmatic attacks;
Special Senses: lacrimation, miosis.

We have low BP, tachy may be later

Contraindicated in urinary obstruction

Thanks!

@just_md Thanks for the detailed explanation.

For me the symptoms of cholinergic excess and the fact that the pt is in post operative period were the clues to get to the answer.

 

[podebrad]

thnx a lot...