QuestionMultiA
QuestionChoice
33887
b
Amlodipine;5mg;Oral (PO);Daily
QuestionChoice
33886
a
Metformin hydrochloride;500mg;Oral (PO);8-hourly
QuestionChoice
33892
g
Gliclazide;40mg;Oral (PO);Daily
QuestionChoice
33888
c
Warfarin sodium;5mg;Oral (PO);Daily
QuestionChoice
33889
d
Carvedilol;3.125mg;Oral (PO);12-hourly
QuestionChoice
33893
h
Amitriptyline hydrochloride;75mg;Oral (PO);Daily in the evening
QuestionChoice
33890
e
5% Chloramphenicol;2-3 drops;Ear drops;8-hourly
QuestionChoice
33891
f
Promethazine hydrochloride;10mg;Oral (PO);8-hourly
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
2725
Drugs causing drowsiness & constipation
Topic
74
Elderly Care
1. Confusion is a common or very common side effect of a beta-adrenoceptor blocker such as carvedilol. Drowsiness is also listed as a common or very common side effect of amitriptyline. Promethazine is also known to cause drowsiness although the frequency of such side effect is unknown. Patients taking these medications should be reminded that their performance of skilled tasks like driving and operating heavy machinery could be affected.
2. Constipation is a common or very common side effect of amlodipine, and can also be caused by amitriptyline due to its anticholinergic activity.
6792
d f h
h b
Case presentation: A 80-year old man is taken to A&E via ambulance after being found lying on the floor by his daughter. His daughter reports that his father has become increasingly drowsy and confused over the past few days. His father has also been complaining of constipation recently. **PH:** Atrial fibrillation, Congestive Cardiac Failure, Type 2 Diabetes Mellitus, Hayfever, Neuropathic pain, Otitis externa **DH:** His current regular prescriptions are listed below


**On examination**: Abbreviated Mental Test Score 6/10. Chest is clear with no added lung sounds. Heart sounds I + II + 0. Abdomen soft and non tender. Bruises on left hip with no active bleeding. Pain on external rotation of left leg.
**Vital signs**: BP 125/80, Temperature 36.8°C, HR 80, O2 Sat 99% (room air), RR 18

Question 1: Select the THREE prescriptions that are most likely to be a cause of the drowsiness and confusion (mark them with a tick in column A)
Question 2: Select the TWO prescriptions that are most likely to be a cause of his constipation (mark it with a tick in column B)