Suicide attempts by ingesting 25 tablets of extra strength acetaminophen

[Oak]

A 22 year old woman is despondent that her husband left her for another woman. She attempts suicide by ingesting 25 tablets of extra strength acetaminophen. Her mother finds her and the empty bottle a couple of hours later and immediately rushes her to the emergency room. Which of the following drugs will most likely be given to this patient?

A. Acetylcysteine
B. Atropine
C. Penicillamine
D. Pralidoxime
E. Protamine

[Rajiv]

N-Acetylcysteine

[Hero]

Yes, I also go with (a) Acetylcysteine-- N-AcetylCysteine(NAC). This is the drug of choice in acetaminophen (paracetamol) overdose--more than or equal to 150 mg/kg?? This women ingested 25 tabs of extra strength pacacetamol (extra strenght is 500 mg I think) --which means she has ingested 12,500 mg paracetamol which is an absolute indication for NAC administration.

[bharat]

yes i also think N-Acetylcystiin should be administered in over dose .
well here are some data relating to it. hope u all like it.
Normally, N-acetyl-para-benzo-quinoneimine (NAPQI) is rapidly metabolized to nontoxic
cysteine and mercapturic acid conjugates or back to the parent compound acetaminophen.
In an overdose, the increased acetaminophen level can saturate the sulphate conjugation pathway and the total amount of NAPQI formed is increased. As indicated above, acetaminophen toxicity is influenced by factors that cause glutathione depletion, increase the formation of NAPQI or reduce the antioxidative capacity of the liver. NAPQI begins to accumulate once glutathione stores are depleted by ~70%. In significant overdoses, hepatic glutathione becomes depleted and the formation of the reactive intermediate metabolites outstrips their detoxification.
Cell injury is believed secondary to covalent binding of NAPQI to cell macromolecules with subsequent arylation, oxidation and inhibition of cellular enzymes, such as glutathione peroxidase, thiol transferases, Ca2+-ATPases and calcium translocases. In vitro, NAPQI can also activate the conversion of xanthine dehydrogenase to xanthine oxidase, thereby potentially increasing oxidant generation.


Commonly found dosage forms and strengths:
· Suppository: 120 mg, 125 mg, 325 mg, 650 mg
· Chewable tablets: 80 mg
· Junior tablets: 160 mg
· Regular strength: 325 mg
· Extra strength: 500 mg
· Liquid: 160 mg/ teaspoon
· Drops: 100 mg/mL, 120 mg/2.5 mL
Symptoms
# Body as a whole
# Sweating
# Convulsions
# Abdominal pain
# Gastrointestinal
# Diarrhea
# Upset stomach
# Appetite loss
# Nausea and/or vomiting
# Nervous system
# Irritability
# Coma
Note: Symptoms may be delayed for 12 or more hours after the acetaminophen was swallowed.
Home Treatment
There is no home treatment. Contact Poison Control immediately if someone has consumed an overdose of acetaminophen
Extreme overdose of acetaminophen can lead to death in several days but can be treated effectively if rapid treatment is administered.
What to expect at the emergency room
Some or all of the following procedures may be performed:
· Administer activated charcoal.
· Administer a laxative.
· Monitor blood levels of acetaminophen.
· Depending on blood levels, administer an antidote over a period of several days.
· Treat the symptoms.

[Anup'da]

i agree with them

n-acety cysteine should be the drug

[Oak]

Sorry gusy, I got little late, yh the correct answer is A. Acetylcysteine (N-acetylcysteine) is the antidote for acetaminophen overdose. It likely acts by replenishing hepatic stores of glutathione, which become depleted in the effort to metabolize the acetaminophen. It is most effective if administered within 10 hours of acetaminophen ingestion.

Atropine (choice B) is a muscarinic receptor antagonist used in the treatment of cholinesterase inhibitor poisoning.

Penicillamine (choice C) is a chelating agent used to treat poisoning with copper, lead, arsenic, and gold.

Pralidoxime (choice D) is an acetylcholinesterase reactivating agent that is used in organophosphorus cholinesterase inhibitor poisoning.

Protamine (choice E) is used for heparin overdose. Protamine is a basic peptide that binds heparin to form a stable complex devoid of anticoagulant activity.