case 1:

An elderly man is brought by ambulance into the emergency ward of a local hospital after he was anonymously reported (a call to 911) to be wandering aimlessly around the neighborhood in obvious distress. Upon admission, the patient is highly disheveled, and his clothes reek of urine, vomitus, and fecal material. His symptoms are: bradycardia; shallow pulse, 60 bpm by palpation; profuse sweating, and periodic twitching. A medic alert bracelet on his wrist indicates that he is suffering from Alzheimer's disease. When contacted, the patient's caretaker reveals that the elderly gentleman takes tetrahydroaminoacridine(Tacrine) (figure 1) for his condition. For treatment of his resistant reflux esophagitis, the patient has been taking metoclopramide (figure 2) 10 mg qid, Mylanta prn, plus a new medication, bethanechol (figure 3) 25 mg qid, which he began 5 days previous to admission.

1. Indicate the likely cause(s) of the patient's symptoms. Explain fully.

2. Select the appropriate drug from the structures provided to antidote the patient's symptoms. Defend your choice.

Case 2:

A new (aerosol dosage form) drug of the following structure was recently approved by the FDA as Class 1-B.

A new medical doctor asked our clinical pharmacist to answer the following questions:

1. What category does this drug belong to?

2. What is its recommended therapeutic use?

3. How does this drug differ from atropine structurally? Will it have any CNS activity?

4. Is this drug a natural product or a synthetic compound?

amide Figure 3 Bethanechol