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A patient is admitted to the intensive care unit with sudden-onset shortness of breath and chest pain
followed by pulseless electrical activity arrest. After cardiopulmonary resuscitation, the patient is
dependent on vasopressors. The patient is 45 years old and is undergoing therapy for metastatic breast
cancer. She complained to her husband 3 days earlier that her left leg was slightly more swollen than her
right. Current medications, aside from the chemotherapy regimen, include furosemide, tamoxifen,
pantoprazole, and diazepam. Physical examination is notable for cool extremities, tachycardia, elevated
jugular venous pressure, and a right ventricular heave. Lungs are clear.
The patient survives and is ready for discharge from the hospital. Which of the following medications
should be discontinued?
A. Diazepam
B. Furosemide
C. Pantoprazole
D. Tamoxifen
E. None of the above
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could you explain the answers please?
i was thinking pantoprazole, but despite that it is metabolized in liver by citocrome 450 no reaction with warfarine are seen.
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well guys...to get the answer u must think about the problem she had...what could be the cause of her asystole
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hi darkhorse,...i commend your work on this forum...kuddos to you.
I must say that labelling questions as "easy" is sort of odd. Why dont we not predetermine the level of ease or difficulty for others. Human nature is an intersting thing. Some people have more difficulty finding the answer when its the process is confined to what some call as easy or difficult.
Dont take it to heart. Im offering some constructive critism....thats what this forum is all about. Ive been in the field of psychology now for 3 years......thats what ive noticed with my students. good luck to you.
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tx vikasi.....i take the point....but i really thought it was easy....the point of labelling this as easy was to attract more people to attempt...
this lady had PE as u can imagine...she has cancer...swollen leg...started with chest pain and SOB and went into asystole....that was a clear scenario...the only difficult part of the question is to know that tamoxifen causes DVT.....but anyway....i will remember what u said next time
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The answer is D.
The patient presents with a classic history for acute pulmonary embolism with acute onset of shortness
of breath and chest pain in the setting of risk factors for malignancy and tamoxifen use. Although most
patients with a submassive pulmonary embolism can be managed with unfractionated or
low-molecular-weight heparins, this patient has a life-threatening pulmonary embolism. In light of the
recent arrest and vasopressor-requiring hypotension, which are manifestations of obstructive shock,
thrombolytic therapy is indicated. Although recent trials have shown that fondaparinux is safe and
effective in the treatment of hemodynamically stable pulmonary embolism compared with intravenous
unfractionated heparin, that finding does not apply to this patient. Similarly, subcutaneous
low-molecular-weight heparins are not indicated in therapy for a massive pulmonary embolism.
Intra-aortic balloon pump placement is used for cardiogenic shock, not for obstructive shock. Upon
discharge, medications that potentially cause thrombophilia should be discontinued. Tamoxifen has been
associated with an increased risk of thromboembolic disease.
