A 60-year-old man presents with difficulty sleeping and conc

A 60-year-old man comes to the physician because of difficulty sleeping and concentrating and a 5-kg (10-lb) weight loss over the past 3 months. He also has become withdrawn. He has had chronic pain since sustaining fractures of the left lower extremity, pelvis, and several ribs in a motor vehicle collision 2 years ago. He has a previous history of alcohol abuse. He takes a nonsteroidal anti-inflammatory drug. Which of the following is the most appropriate pharmacotherapy?

A ) Carbamazepine
B ) Chlordiazepoxide
C ) Disulfiram
D ) Lithium carbonate
E ) Nortriptyline

it is E, since TCA has both the anti anxiety (panic) and the treatment for the chronic pain.

nortriptyline might be the best med. It improves the quality of sleep in chronic pain patients, it raises the pain threshold and has muscle relaxant qualities. It also might help the patient's depressive symptoms but that would occur at a higher dose than that needed for pain control. lithium, carbamazepine, chlordiazepoxide and disulfiram will not address his pain, sleep difficulty nor are they first line meds to treat the patient's mood problems, difficulty concentrating etc. Concerning the h/o etoh abuse, disulfiram might help the patient stay away form etoh but it will not address any of the other problems listed in the stem.