Question

(please give me the right answer without the explanation)

A 56 year old woman has presented to A&E with sudden onset drowsiness, nausea and vomiting. She is hypoxic, with hypotension and tachycardia. On examination she has reduced level of consciousness and pinpoint pupils. You notice that she has a past medical history of osteoarthritis and has had input with your trust’s ‘Crisis Team’ in the past two weeks. Which of the following medications is she most likely to have taken in overdose?

A. Paracetamol

B. Aspirin

C Codeine

D Amitriptyline

E Naproxen

2- A 66 year old gentleman with a past medical history of epilepsy was admitted to the acute medical unit 2 months ago with shortness of breath and tachycardia. He subsequently had a CT pulmonary angiogram which identified a pulmonary embolism. As a result of this he was started on warfarin as anticoagulation. Initially he met his target INR of 2.5, however this gradually began to increase and today he has presented with an INR of 6. Which of the following medications could be causing such an effect on this gentleman’s INR?

A. Carbamazepine

B. Phenytoin

C. Sodium valproate

D. Rifampicin

E .Chronic alcohol intake

Answer 1

1) Answer is C, Codeine

The above stem relates to medication overdose. This patient is experiencing respiratory depression and pinpoint pupils. These are hallmarks of opioid overdose. Codeine is the only opioid analgesic offered as an answer. The patient’s past medical history of chronic arthritis pain may also strongly suggest analgesia overdose. Therefore the answer is C.

2) Answer is C, sodium valproate

This question is demonstrating an example of cytochrome P450 inhibition. The effect of warfarin is being gradually increased, as per inhibition. The only answer in the options available which is an inhibitor is sodium valproate. Therefore the answer is C.