A 50-year-old man is brought to the emergency department after an episode of myoclonic jerking movements and urinary incontinence. After regaining consciousness, the patient has no recollection of what happened and seems confused. He has bipolar disorder, which has been controlled with maintenance therapy for the past 11 years, as well as hypertension, Over the past week, the patient started taking several daily doses of a new medication following an ankle trauma.. His pulse is 92/min and blood pressure is 135/87 mm Hg.. Coarse tremors are noted in the upper extremities. Deep tendon reflexes are 2+ in the bilateral extremities. Gait is mildly ataxic. A drug interaction involving which of the following medications is most likely causing this patient's symptoms?

Question

A 50-year-old man is brought to the emergency department after an episode of myoclonic jerking movements and urinary incontinence. After regaining consciousness, the patient has no recollection of what happened and seems confused. He has bipolar disorder, which has been controlled with maintenance therapy for the past 11 years, as well as hypertension, Over the past week, the patient started taking several daily doses of a new medication following an ankle trauma.. His pulse is 92/min and blood pressure is 135/87 mm Hg.. Coarse tremors are noted in the upper extremities.  Deep tendon reflexes are 2+ in the bilateral extremities.  Gait is mildly ataxic.  A drug interaction involving which of the following medications is most likely causing this patient's symptoms?

Quizplus · Accepted Answer

Eductional Objective: Lithium is commonly used for maintenance therapy of bipolar disorder. This patient has lithium toxicity, which can cause myoclonic seizures, altered mental status, coarse tremors, and neuromuscular excitability. Nonsteroidal anti-inflammatory drugs, thiazide diuretics, ACE inhibitors, tetracyclines, and metronidazole can cause lithium toxicity.

A 50-Year-Old Man Is Brought to the Emergency Department After