LN is 84 YOM who is in hospital for a back surgery. His height is 5 feet and 4 inches, weight 85 kg and NKDA. His past medical history includes hypertension, diabetes mellitus, major depression, hypothyroidism and chronic back pain. Post-op day 1, LN’s medication includes Dexamethasone 8 mg iv q6h with taper dosing, Ondansetron 4 mg iv q6h prn for N/V, Levothyroxine 0.075 mg po daily, Lisinopril 10 mg po daily, Citalopram 20 mg po daily, Docusate sodium / Senna 1 tab po twice a day, Bisacodyl 10 mg suppository daily prn for constipation, Famotidine 20 mg iv q12hr, Metoclopramide 10 mg iv q6h, Metformin 500 mg po bid, D51/2NS with 20 K at 125 mls/hour and Hydromorphone PCA at 0.2 mg/hour of basal rate, demand dose 0.1 mg. lock-out every 6 min, one hour limit 2.2 mg/hour. Pertinent morning labs includes serum creatinine 1.4 mg/dl, Mg 1.5 mg/dl, K5.0 mmol/L, Na 135 mmol/L.
Which of the following medication may cause tardive dyskinesia when given at a higher dose and for a long duration?
- Lisinopril
- Dexamethasone
- Famotidine
- Metoclopramide
- Hydromorphone
Answer(s): D
Explanation:
Metoclopramide may cause tardive dyskinesia when given at a higher dose and for a long duration of time of more than 3 months. Tardive dyskinesia is also listed as a Boxed Warning for metoclopramide. Tardive dyskinesia is a serious movement disorder that is irreversible. The risk increases with duration of treatment
and the total cumulative dose. If signs or symptoms of tardive dyskinesia develop, then metoclopramide should be discontinued. There is currently no known treatment for it, but symptoms can lessen or resolve after metoclopramide is stopped. Treatment should not be more than 12 weeks unless the benefits outweigh the risks of developing tardive dyskinesia.
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