A 53-year-old man comes to the emergency department due to sudden onset of nausea, vomiting, and severe epigastric pain radiating to the back. He has no constipation, diarrhea, or black stools. His medical history includes epilepsy, hypertension, and depression. The patient was recently treated for cellulitis. He does not use tobacco, alcohol, or illicit drugs. Temperature is 37.8 C (100 F), blood pressure is 130/80 mm Hg, pulse is 118/min, and respirations are 20/min. The abdomen is tender in the epigastric region. Laboratory results are as follows: Which of the following is the most likely cause of this patient's symptoms?
A)Amlodipine
B)Cephalexin
C)Chlorthalidone
D)Fluoxetine
E)Metoprolol

Question

A 53-year-old man comes to the emergency department due to sudden onset of nausea, vomiting, and severe epigastric pain radiating to the back.  He has no constipation, diarrhea, or black stools.  His medical history includes epilepsy, hypertension, and depression.  The patient was recently treated for cellulitis.  He does not use tobacco, alcohol, or illicit drugs.  Temperature is 37.8 C (100 F), blood pressure is 130/80 mm Hg, pulse is 118/min, and respirations are 20/min.  The abdomen is tender in the epigastric region.  Laboratory results are as follows:  Which of the following is the most likely cause of this patient's symptoms?
A)Amlodipine 
B)Cephalexin 
C)Chlorthalidone 
D)Fluoxetine 
E)Metoprolol

Quizplus · Accepted Answer

Explanation: 11ec2b69_c14b_4aa7_8f63_5f332e01034d_MD0005_00 Drug-induced pancreatitis (DIP) accounts for approximately 1% of cases of pancreatitis. Thiazide diuretics (eg, hydrochlorothiazide, chlorthalidone) and most loop diuretics (eg, furosemide) belong to the sulfonamide class of drugs and have been associated with DIP. These drugs likely cause DIP through several pathophysiologic mechanisms, which include hypersensitivity to the sulfonamide molecule, ischemia due to decreased intravascular blood volume, and increased viscosity of pancreatic secretions. Numerous other medications have been associated with DIP and act through the same or other pathophysiologic mechanisms (eg, toxicity from metabolites, intravascular thrombosis). Diagnosing DIP can be difficult and requires careful consideration of the patient's medication history. Although the rates of DIP for any specific medication are low, certain medications are more strongly associated with the disease. Given the wide range of medications involved, physicians should be aware of a number of common groups of patients who are at higher risk for DIP. These include patients with the following: Heart failure or hypertension (ACE inhibitors, angiotension II receptor blockers, diuretics) Autoimmune disease (azathioprine, mesalamine, corticosteroids) Chronic pain (acetaminophen, opiates, nonsteroidal anti-inflammatory drugs) Seizure disorder (valproic acid, carbamazepine) HIV (lamivudine, didanosine, trimethoprim-sulfamethoxazole) (Choices A, B, D, and E) Although ACE inhibitors and angiotensin II receptor blockers have been consistently implicated in DIP, calcium-channel blockers and beta blockers have not been identified as significant causes. Likewise, many antibiotics, including metronidazole, tetracyclines, and isoniazid, have been associated with DIP, but cephalexin has not. In addition, among the selective-serotonin reuptake inhibitors, sertraline has been reported to cause DIP, but there are no reports for fluoxetine. Educational objective: Drug-induced pancreatitis is an uncommon but important cause of pancreatitis, and many medications have been associated with the disease. Diuretics (eg, hydrochlorothiazide, chlorthalidone, furosemide) are particularly important drugs that have been implicated in this disease. References: Drug-induced pancreatitis. (http://www.ncbi.nlm.nih.gov/pubmed/22314811) Drug-induced acute pancreatitis: an evidence-based review. (http://www.ncbi.nlm.nih.gov/pubmed/17395548)

A 53-Year-Old Man Comes to the Emergency Department Due to Sudden