00:01
Let's move on to a question.
00:03
Let's take a look at this particular case.
00:06
A 66-year-old Sen. presents to the emergency department with a rapid heart rate.
00:11
He's tremulous. He's diaphoretic. He's agitated. And he's confused.
00:17
He has a blood pressure of 166/110 and a heart rate of 130.
00:23
He has hyperreflexia. He has peripheral clonus.
00:28
And he has exaggeration of the reflexes in the lower extremities.
00:32
He was recently placed on Sertraline for depression he has a history of Parkinson's disease.
00:38
He has a history of hypertension and he has a history of hyperlipidemia.
00:42
His medications are Sertraline, Rosuvastatin, Bisoprolol, valsartan and Selegiline.
00:49
Pick the true statement.
00:52
What are the choices?
A: the Sertraline has interacted with the Bisoprolol making it inactive.
00:59
B: the Sertraline has interacted with the Rosuvastatin, causing toxicity and rhabdomyolysis.
01:06
C: the Sertraline has interacted with the anti-Parkinsonian medication, Selegiline.
01:12
Or D: the Sertraline has interacted with valsartan, precipitating a hypertensive crisis.
01:19
Which is the correct answer?
Great. You picked C.
01:24
The Sertraline has interacted with his antiparkinsonian medications, Selegiline.
01:30
Let's talk about the answers associated with this.
01:34
Number A: Sertraline has interacted with the Bisoprolol, rendering it inactive.
01:38
That's not particularly a reasonable thing to say.
01:41
You may explain the tachycardia with that but really, you don't explain the high blood pressure.
01:47
You don't explain the other neurological symptoms.
01:50
B: the Sertraline has interacted with the Rosuvastatin, causing toxicity and rhabdomyolysis.
01:56
Again, that doesn't explain the tachycardia,
the high blood pressure and some of the neurological symptoms.
02:01
And D is wrong. Sertraline has interacted with the valsartan, precipitating a hypertensive crisis.
02:06
That's not reasonable because you wouldn't get the high blood pressures
and you wouldn't get the neurological symptoms.
02:12
And just FYI, valsartan doesn't interact with that drug, so it seems very unlikely.
02:18
Okay that's it, you guys survived.
02:21
You got - you guys will go through your exams and you'll do very well.
02:25
Show them what you know.