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Aspirin
0%
0/5
Amlodipine
Gabapentin
Glyburide
Metoclopramide
100%
5/5
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The patient’s clinical presentation of abnormal slow movements is most consistent with extrapyramidal symptoms. Of the drugs listed, metoclopramide is the only one likely to cause this reaction with prolonged use. The patient has a history of uncontrolled diabetes and is suffering from vascular and neurological complications. One complication is gastroparesis, which can lead to nausea and vomiting. Metoclopramide is an antiemetic and promotility agent sometimes prescribed to treat these symptoms. However, prolonged use of metoclopramide can lead to extrapyramidal symptoms. Flake et al. state that nausea and vomiting are controlled by visceral, vestibular and central nervous systems by various neurotransmitters such as dopamine. Dopamine antagonists, such as metoclopramide, block chemoreceptors in the intestines and the chemoreceptor trigger zone (CTZ) that is located in the central nervous system at the base of the fourth ventricle. Common side effects include sedation, orthostatic hypotension, and extrapyramidal symptoms like tardive dyskinesia. Rare side effects include seizures, agranulocytosis, neuroleptic malignant syndrome and blood dyscrasias. In a case-control study, Ganzini et al. showed that patients treated with metoclopramide for greater than three months showed an increase risk of developing tardive dyskinesia and parkinsonism symptoms. Derinoz et al. have shown that 93% of patients who were treated with diphenhydramine, which has central anticholinergic effects, had improvement in extrapyramidal symptoms. Similarly, Adler et al. demonstrated that benztropine, an anticholinergic drug, improves akathesia within several days after treatment. Therefore, both benztropine and diphenhydramine may be used to treat metoclopramide extrapyramidal reactions. However, the best treatment, of course, would be to avoid using dopamine antagonists for a prolonged period of time. Incorrect Answers: Answer 1: A common side effect of aspirin is bleeding. Answer 2: Common side effects of amlodipine include headache and lower extremity swelling. Answer 3: Side effects of gabapentin include drowsiness, loose stools, nausea and abdominal pain. Answer 4: A common side effect with glyburide is hypoglycemia.
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