QuestionMultiA
QuestionChoice
33798
d
Acebutolol;400mg;oral (PO);12-hourly
QuestionChoice
33803
i
Diazepam;2mg;oral (PO);8-hourly
QuestionChoice
33797
c
Indapamide;1.5mg;oral (PO);Daily
QuestionChoice
33795
a
Amlodipine;10mg;oral (PO);Daily
QuestionChoice
33796
b
Ramipril;2.5mg;oral (PO);Daily
QuestionChoice
33802
h
Co-codamol 8-500mg;1 tablet;oral (PO);6-hourly
QuestionChoice
33799
e
Tamsulosin;400micrograms;oral (PO);Daily
QuestionChoice
33801
g
Omeprazole;40mg;oral (PO);Daily
QuestionChoice
33800
f
Dexibuprofen;200mg;oral (PO);8-hourly
QuestionComment
diazepam and co codamol can definitely cause confusion in an elderly patient... 
36681
User
subscriber
Serotonin Dorsal
QuestionComment
this has got an error?! correct explanation but you've marked the wrong answers 
36682
User
subscriber
Serotonin Dorsal
QuestionComment
BNF says dexibuprofen -> “Patients commonly present with confusion” ?!
54465
User
subscriber
Lo
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2713
Drugs causing confusion and bradycardia
Topic
74
Elderly Care
1. The patient has developed AKI, which can result in a reduction in the clearance of his medication and an increase in adverse effects. The mechanism for confusion caused by benzodiazepine and codeine remains unknown, although the incidence is noted to be higher in the elderly population and in patient with decreased renal function due to a reduction in the clearance of the medication. Similarly, in geriatric patients, the bioavailability of acebutolol and its metabolite increases approximately by two-fold, due to the decrease in first pass metabolism and renal function in the elderly. Retention of codeine (co-codamol), diazepam and acebutolol in this patient may contribute to the patient’s confusion
2. Acebutolol is a cardio-selective beta-adrenergic antagonist, which acts on the beta-1 receptors in the heart causing a reduction in heart rate and contractility. Ramipril can cause arrythmia but acebutolol, specifically, causes bradycardia.
6780
d h i
d
Case presentation: A 75-year-old man is admitted to the care of the elderly ward following a urinary tract infection. PH Hypertension, Alzheimer’s Disease, BPH, Osteoarthritis, Severe anxiety. DH. His current regular medications are listed (below).




 **On Examination**

HR 50/min regular, BP 135/75mmHg. He appears confused.


 **Investigation**


||||
|---------------------------|:-------:|--------------------|
|Urea|8.5 mmol/L|2.5 - 7.8|
|Creatinine|125 µmol/L|60 - 120|


Question 1: Select the THREE prescriptions that are most likely to be contributing to his confusion (mark them with a tick in column A)

Question 2: Select the ONE prescriptions that are most likely to be a cause of his bradycardia (mark them with a tick in column B).