WBR0768: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{YD}} (Reviewed by  {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|Prompt=A 27 year old female patient is brought to the emergency department (ED) with severe abdominal pain and nausea. Her vital signs show a temperature of 36.8 degrees C (98.24 degrees F), a heart rate of 88 bpm, and a blood pressure measuring 128/78 mmHg. Her husband arrives to the ED shortly and informs the physician that the patient had ingested more than 20 tables of acetaminophen 5 hours before admission in an attempt to commit suicide. The physician decides to administer a medication to reduce the effect of toxicity. What is another indication for the same medication to be used for this patient's condition?
|MainCategory=Pharmacology
|Explanation=The patient is presenting with acetaminophen (paracetamol) toxicity. When patients present with delay, awaiting the serum levels of acetaminophen may not be very helpful. As such, giving N-acetylcysteine before the serum levels of acetaminophen are available becomes necessary. Symptoms of acetaminophen overdose are generally non-specific, such as abdominal pain and nausea.  
|SubCategory=Pulmonology, General Principles
 
|MainCategory=Pharmacology
N-acetylcysteine is an anti-oxidant that may be used to reduce the effect of acetaminophen (paracetamol) toxicity by the regeneration of glutathione and reduction of toxic reactive oxygen species (ROS). N-acetylcysteine is also a mucolytic that is usuaully use in patients with cystic fibrosis.
|SubCategory=Pulmonology, General Principles
 
|MainCategory=Pharmacology
Educational Objective: N-acetylcysteine is used as an antidote to reduce the toxicity of acetaminophen (paracetamol). It is also a mucolytic used in patients with cystic fibrosis.
|SubCategory=Pulmonology, General Principles
|AnswerA=Mucolysis
|MainCategory=Pharmacology
|AnswerAExp=N-acetylcysteine is a mucolytic that is frequently used in patients with cystic fibrosis (CF)
|MainCategory=Pharmacology
|AnswerB=Decongestion
|MainCategory=Pharmacology
|SubCategory=Pulmonology, General Principles
|MainCategory=Pharmacology
|SubCategory=Pulmonology, General Principles
|MainCategory=Pharmacology
|SubCategory=Pulmonology, General Principles
|MainCategory=Pharmacology
|SubCategory=Pulmonology, General Principles
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Pulmonology, General Principles
|Prompt=A 27-year-old woman is brought to the emergency department (ED) with severe abdominal pain and nausea. Her temperature is 36.8 °C (98.24 °F), heart rate is 88/min, and blood pressure is 128/78 mmHg. Her husband arrives to the ED shortly and informs the physician that the patient attempted suicide and ingested more than 20 tables of acetaminophen 5 hours before admission. The physician promptly administers an antioxidant drug that regenerates glutathione and reduces the effect of acetaminophen toxicity. The administered drug is also indicated to manage which condition?
|Explanation=The patient is presenting with acetaminophen (paracetamol) toxicity. When patients with acetaminophen toxicity present late, it is not necessary to wait for the the serum concentration of acetaminophen, and administration of N-acetylcysteine prior to the return of serum concentration of acetaminophen is necessary. Symptoms of acetaminophen overdose are generally non-specific, and typical manifestations include abdominal pain and nausea. N-acetylcysteine is an antioxidant that regenerates glutathione and reduces the generation of toxic reactive oxygen species (ROS). It is used to reduce the effect of acetaminophen (paracetamol) toxicity. In addition, N-acetylcysteine is a mucolytic agent that is usually used to manage mucus plugging in patients with cystic fibrosis and chronic obstructive pulmonary disease (COPD).
|AnswerA=Mucus plugging
|AnswerAExp=N-acetylcysteine is an antioxidant and mucolytic agent that is frequently used to manage mucus plugging in patients with cystic fibrosis and COPD.
|AnswerB=Nasal congestion
|AnswerBExp=N-acetylcysteine is not a decongestant.
|AnswerBExp=N-acetylcysteine is not a decongestant.
|AnswerC=Exercise-induced asthma
|AnswerC=Exercise-induced asthma
Line 18: Line 33:
|AnswerE=Gastoesophageal reflux disease (GERD)
|AnswerE=Gastoesophageal reflux disease (GERD)
|AnswerEExp=N-acetylcysteine is not generally used to treat GERD.
|AnswerEExp=N-acetylcysteine is not generally used to treat GERD.
|EducationalObjectives=N-acetylcysteine is an antioxidant and mucolytic agent that is frequently used to manage mucus plugging in patients with cystic fibrosis and COPD.
|References=Sadowska AM, Verbraecken J, Darquennes K, et al. Role of N-acetylcysteine in the management of COPD. Int J Chron Obstruct Pulmon Dis. 2006;1(4):425-34.<br>
First Aid 2014 page 88, 252
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=acetaminophen, paracetamol, toxicity, overdose, suicide, attempt, commit, N-acetylcysteine, acetylcysteine, antidote, glutathione, regeneration, repletion, depletion, reactive, oxygen, species, mucolysis, mucolytic, cystic, fibrosis
|WBRKeyword=Acetaminophen, Paracetamol, Toxicity, Overdose, Suicide, N-acetylcysteine, Acetylcysteine, COPD, Antioxidant, Antidote, Glutathione, Reactive oxygen species, Mucolysis, Cystic fibrosis
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 01:38, 28 October 2020
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology
Sub Category SubCategory::Pulmonology, SubCategory::General Principles
Prompt [[Prompt::A 27-year-old woman is brought to the emergency department (ED) with severe abdominal pain and nausea. Her temperature is 36.8 °C (98.24 °F), heart rate is 88/min, and blood pressure is 128/78 mmHg. Her husband arrives to the ED shortly and informs the physician that the patient attempted suicide and ingested more than 20 tables of acetaminophen 5 hours before admission. The physician promptly administers an antioxidant drug that regenerates glutathione and reduces the effect of acetaminophen toxicity. The administered drug is also indicated to manage which condition?]]
Answer A AnswerA::Mucus plugging
Answer A Explanation AnswerAExp::N-acetylcysteine is an antioxidant and mucolytic agent that is frequently used to manage mucus plugging in patients with cystic fibrosis and COPD.
Answer B AnswerB::Nasal congestion
Answer B Explanation AnswerBExp::N-acetylcysteine is not a decongestant.
Answer C AnswerC::Exercise-induced asthma
Answer C Explanation AnswerCExp::N-acetylcysteine is not generally used to treat exercise-induced asthma.
Answer D AnswerD::Bronchoconstriction
Answer D Explanation AnswerDExp::N-acetylcysteine is not generally used to treat bronchoconstriction.
Answer E AnswerE::Gastoesophageal reflux disease (GERD)
Answer E Explanation AnswerEExp::N-acetylcysteine is not generally used to treat GERD.
Right Answer RightAnswer::A
Explanation [[Explanation::The patient is presenting with acetaminophen (paracetamol) toxicity. When patients with acetaminophen toxicity present late, it is not necessary to wait for the the serum concentration of acetaminophen, and administration of N-acetylcysteine prior to the return of serum concentration of acetaminophen is necessary. Symptoms of acetaminophen overdose are generally non-specific, and typical manifestations include abdominal pain and nausea. N-acetylcysteine is an antioxidant that regenerates glutathione and reduces the generation of toxic reactive oxygen species (ROS). It is used to reduce the effect of acetaminophen (paracetamol) toxicity. In addition, N-acetylcysteine is a mucolytic agent that is usually used to manage mucus plugging in patients with cystic fibrosis and chronic obstructive pulmonary disease (COPD).

Educational Objective: N-acetylcysteine is an antioxidant and mucolytic agent that is frequently used to manage mucus plugging in patients with cystic fibrosis and COPD.
References: Sadowska AM, Verbraecken J, Darquennes K, et al. Role of N-acetylcysteine in the management of COPD. Int J Chron Obstruct Pulmon Dis. 2006;1(4):425-34.
First Aid 2014 page 88, 252]]

Approved Approved::Yes
Keyword WBRKeyword::Acetaminophen, WBRKeyword::Paracetamol, WBRKeyword::Toxicity, WBRKeyword::Overdose, WBRKeyword::Suicide, WBRKeyword::N-acetylcysteine, WBRKeyword::Acetylcysteine, WBRKeyword::COPD, WBRKeyword::Antioxidant, WBRKeyword::Antidote, WBRKeyword::Glutathione, WBRKeyword::Reactive oxygen species, WBRKeyword::Mucolysis, WBRKeyword::Cystic fibrosis
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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