Question

Patient information:

A 74 year-old woman from Baltimore, MD admitted to the ER.  She has history of hypertension and GERD.  She is on medication for hypertension (Lopressor) and GERD (Zantax). She has been on these medication for over 2 years.  No new medications have been added, and she denies using any other over-the-counter medications, alcohol, tobacco products, or illegal drugs

Conditions presented:

Sudden onset of dizziness (6 hrs prior to the admission)

Generalized weakness

Imbalance

Double vision

Vitals:

BP: 171/99

Pulse: 85

ECG: normal

Sat O2: 95 %

Blood chemistry: normal

Pupil: Small (1.5 mm diam), equal, non-reactive bilateral

Other noticeable signs:

Mild disconjugate gaze with slightly deviated right eye (shift to right)

1. Identify the type/class of medication that she is currently taking and describe how they work (2 pts)

2. What could be the cause of her conditions, and how could her medications possibly contribute? (2 pts)

3. What does small pupils observed here indicate? (2 pts)

4. Based on the conditions described and what you know about medications, what do you think she is suffering from? (2 pts)

Answer 1

#. Lopressor :-

Class - beta blocker

Action :-

blocks stimulation of beta adrenergic receptors, decreases cardiac output, blood pressure and heart rate

Zantax :-

Class - Histamine H2 antagonist

Actions :-

inhibits the action of histamine h2 receptor site located primarily in gastric parietal cells, inhibiting gastric acid secretion

#. The cause of her condition is her hypertensive condition .

#. Pupils that are abnormally small under normal lighting conditions are called pinpoint pupils.

#. The patient is suffering from uncontrolled hypertension.