WBR0768

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pharmacology
Sub Category	SubCategory::Pulmonology, SubCategory::General Principles
Prompt	[[Prompt::A 27-year-old woman is brought to the emergency department (ED) with severe abdominal pain and nausea. Her temperature is 36.8 °C (98.24 °F), heart rate is 88/min, and blood pressure is 128/78 mmHg. Her husband arrives to the ED shortly and informs the physician that the patient attempted suicide and ingested more than 20 tables of acetaminophen 5 hours before admission. The physician promptly administers an antioxidant drug that regenerates glutathione and reduces the effect of acetaminophen toxicity. The administered drug is also indicated to manage which condition?]]
Answer A	AnswerA::Mucus plugging
Answer A Explanation	AnswerAExp::N-acetylcysteine is an antioxidant and mucolytic agent that is frequently used to manage mucus plugging in patients with cystic fibrosis and COPD.
Answer B	AnswerB::Nasal congestion
Answer B Explanation	AnswerBExp::N-acetylcysteine is not a decongestant.
Answer C	AnswerC::Exercise-induced asthma
Answer C Explanation	AnswerCExp::N-acetylcysteine is not generally used to treat exercise-induced asthma.
Answer D	AnswerD::Bronchoconstriction
Answer D Explanation	AnswerDExp::N-acetylcysteine is not generally used to treat bronchoconstriction.
Answer E	AnswerE::Gastoesophageal reflux disease (GERD)
Answer E Explanation	AnswerEExp::N-acetylcysteine is not generally used to treat GERD.
Right Answer	RightAnswer::A
Explanation	[[Explanation::The patient is presenting with acetaminophen (paracetamol) toxicity. When patients with acetaminophen toxicity present late, it is not necessary to wait for the the serum concentration of acetaminophen, and administration of N-acetylcysteine prior to the return of serum concentration of acetaminophen is necessary. Symptoms of acetaminophen overdose are generally non-specific, and typical manifestations include abdominal pain and nausea. N-acetylcysteine is an antioxidant that regenerates glutathione and reduces the generation of toxic reactive oxygen species (ROS). It is used to reduce the effect of acetaminophen (paracetamol) toxicity. In addition, N-acetylcysteine is a mucolytic agent that is usually used to manage mucus plugging in patients with cystic fibrosis and chronic obstructive pulmonary disease (COPD). Educational Objective: N-acetylcysteine is an antioxidant and mucolytic agent that is frequently used to manage mucus plugging in patients with cystic fibrosis and COPD. References: Sadowska AM, Verbraecken J, Darquennes K, et al. Role of N-acetylcysteine in the management of COPD. Int J Chron Obstruct Pulmon Dis. 2006;1(4):425-34. First Aid 2014 page 88, 252]]
Approved	Approved::Yes
Keyword	WBRKeyword::Acetaminophen, WBRKeyword::Paracetamol, WBRKeyword::Toxicity, WBRKeyword::Overdose, WBRKeyword::Suicide, WBRKeyword::N-acetylcysteine, WBRKeyword::Acetylcysteine, WBRKeyword::COPD, WBRKeyword::Antioxidant, WBRKeyword::Antidote, WBRKeyword::Glutathione, WBRKeyword::Reactive oxygen species, WBRKeyword::Mucolysis, WBRKeyword::Cystic fibrosis
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::