nbme 4 - grace72

[ArchivalUser]

19yo college student is brought to ER c/o shortness of breath. started 1hr ago after being picked @ the airport ff a 6hr flight. Px has rapid and shallow breathing and with difficulty says "I cant get my breath, am having chest pains, my face is numb" She's always been healthy, no prior similar hx, she's on OCPs. PE is normal except for tachycardia and tachypnea. EKG shows tachycardia. ABG:
po2 99mmHg
PCO2 30mmhg
pH 7.44
appropriate long term therapy
a. bupoprion
b. gabapentin
c. lorazepam
d. metoprolol
e. paroxetin

[ArchivalUser]

The answer is e, paroxetine, this pt has panic attack, benzodiazepine is the first for acute attack, SSRIs particularly paroxetine (better tolerance than other SSRIs) are first line for long-term control of panic attack. buproprion, gabapentin, and b-blockers can also be used as adjunct trt, they are not FDA approved and their efficacy is not as definitive as benzo and SSRIs.