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NBME 22 Answers

nbme22/Block 4/Question#2 (32.5 difficulty score)
Thirty minutes after taking 2 aspirin tablets ...

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submitted by generic_login(12),
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Thsi si irtilepaiatnnon-rs hm.tsaa nAmohpaiteecn lnyo nbhiitsi COX nihwti teh ,CSN so nsedt’o auesc teh itoleruenek nthingus hatt criaehztcaers thta esi.saed

linwanrun1357  why not triptans? +4  
joyceeepan  the girl has tension headache. Triptans is not a drug of choice. NSAID, Acetaminophen, (or TCA for prophylaxis) +3  
vsn001  but question asks which drug she should take to /treat/ her headache? -> I fell into sumatriptan cause I know it didn't have prophylactic indications but more of a treatment. idk, was between the acetaminophen and sumatriptan, and would appreciate if someone can tell me why acetaminophen is the move for this patient. +2  
texasdude4  for HA treatment you want to start off conservative anyway w/ Tylenol / NSAIDs before you move on to triptans. That and triptans are not used for tension HA +  
jurrutia  Triptans are used for migraine headaches by causing trigeminal vasoconstriction. They are not analgesics. +  

submitted by gainsgutsglory(30),
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yhW si hamcoenitpena eth ecrrtco ranwse erhot tahn sercpos of inn.oliateim AIDNsS anc eb udse fro enintos AH nda eh’ss too ldo rfo eyRe Smdoerny (i naem hlaliecynct eshs a hdcil ceins hess 1t7;&l, btu tno a scacils ueitcrp at l)l.a mI’ cn.sefduo

zelderonmorningstar  My reasoning was that aspirin and the other 3 are all NSAIDs, and she had an adverse reaction. Acetaminophen is not an NSAID, so she probably won’t have the reaction. +  
gainsgutsglory  @zelderon But what’s the pathophys here? +  
generic_login  This is aspirin-intolerant asthma. Acetaminophen only inhibits COX within the CNS, so doesn't cause the leukotriene shunting that characterizes that disease. +3  
pfebo  Acetaminiphen is only antipyretic and analgesic. Does not have anti-inflammatory action like NSAIDs, so it is the most appropriate to treat a headache in a patient with aspirin-induced asthma. +  
pfebo  Also, it is inactive peripherally so less probability of adverse effects +