Poisoning and Overdose 249245.A 33-year-old woman presents to the ED with a painful sprained
ankle. She has a past medical history of depression for which she is taking
phenelzine, a monoamine oxidase inhibitor. After you place an elastic wrap
on her ankle, she asks you to prescribe her some pain medication. Which of
the following medications is contraindicated in patients taking a monoamine
oxidase inhibitor?
a. Ibuprofen
b. Acetaminophen
c. Meperidine
d. Oxycodone
e. Hydrocodone
246.A 27-year-old woman presents to the ED 6 hours after the onset of body
aches, abdominal cramping, and diarrhea. She is currently visiting relatives
and normally lives in another state. She regularly takes six to eight tablets daily
of hydrocodone for chronic low-back pain, sumatriptan for migraines, and
amitriptyline and paroxetine for bulimia nervosa. Her BP is 130/80 mm Hg,
HR is 100 beats per minute, temperature is 98.6°F, RR is 16 breaths per
minute, and oxygen saturation is 99% on room air. Examination shows
diaphoresis, dilated pupils, and piloerection. Neurologically she is moving all
four extremities and you do not note tremors. She is alert and cooperative but
seems restless. She denies hallucinations or suicidal ideations. She becomes
very angry when you ask her for the phone numbers of her regular physicians.
Which of the following is the most likely explanation of her symptoms?
a. Anticholinergic overdose
b. TCA intoxication
c. Ethanol withdrawal
d. Serotonin syndrome
e. Opiate withdrawal