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A 65-year-old male presents to the ER complaining of suprapubic discomfort and anuria. His past medical history is significant for benign prostatic hypertrophy diagnosed one year ago and treated effectively with finasteride. He also has type-2 diabetes, hyperlipidernia and hypertension. He was recently seen in the office for painful peripheral neuropathy. Foley catheter placed in this patient revealed 1000 ml of urine. Which of the following medications most likely have contributed to this patient's current condition?
¢ A. Finasteride O B. Amitriptyline
O C. Duloxetine
O D. Gabapentin
O E. Capsaicin
O F. Carbarnazepine
O G. Atoivastatin
O H. Mefformin
O I. Tamsulosin
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fantastic guys
b correct
This patient most likely has developed acute urinary retention due to the anticholinergic side effect of amitriptyline. TCAs are commonly used for the treatment of painful diabetic neuropathy.
(Choices A and I) Finasteride and tamsulosin are useful for BPH and should not cause urinary retention.
(Cho¢ce C) Duloxetine is a dual serotonin and norepinephrine reuptake inhibitor and is promising for the treatment of painful diabetic polyneuropathy. However, this would not cause anticholinergic side effects.
(Choices 0, E and F) Gabapentin, capsaicin cream and carbamazepine are all useful for the painful neuropathy but none of them cause anticholinergic side effects.
(Choices G and H) Metformin causes lactic acidosis and atorvastatin causes hepatitis and rnyositis. They do not have anticholinergic side effects.
Educational Objective:
Tricyclic antidepressants (TCAs) such as imipramine, doxepin, amitriptyline, and clomipramine have stronger anticholinergic properties than heterocyclics or SSRIs and should be used with caution in patients with benign prostatic hypertrophy (BPH), as they may cause urinary retention.
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