Drug of choice in intractable hiccoughs is:
**Core Concept**
Intractable hiccoughs, also known as intractable hiccup syndrome, is a condition characterized by persistent and unrelenting hiccoughs that do not respond to conventional treatments. The pathophysiology of hiccoughs involves the sudden closure of the glottis, leading to the characteristic "hic" sound, which is mediated by the phrenic nerve and the vagus nerve.
**Why the Correct Answer is Right**
The drug of choice for intractable hiccoughs is baclofen, a GABA_B receptor agonist. Baclofen works by stimulating the GABA_B receptors in the brainstem, which helps to suppress the abnormal neuronal firing that leads to hiccoughs. The mechanism of action of baclofen is thought to involve the inhibition of the phrenic nerve and the vagus nerve, leading to a decrease in the frequency and severity of hiccoughs.
**Why Each Wrong Option is Incorrect**
**Option A:** Chlorpromazine is an antipsychotic medication that may be used to treat hiccoughs, but it is not the first-line treatment for intractable hiccoughs. Chlorpromazine works by blocking dopamine receptors in the brain, which can help to reduce the frequency of hiccoughs, but it is not as effective as baclofen in treating intractable hiccoughs.
**Option B:** Metoclopramide is a prokinetic agent that may be used to treat hiccoughs, but it is not the drug of choice for intractable hiccoughs. Metoclopramide works by blocking dopamine receptors in the gut, which can help to stimulate gastric motility and reduce the frequency of hiccoughs, but it is not as effective as baclofen in treating intractable hiccoughs.
**Option C:** Furosemide is a loop diuretic that may be used to treat hiccoughs, but it is not the first-line treatment for intractable hiccoughs. Furosemide works by increasing urine production and reducing fluid volume in the body, which can help to reduce the frequency of hiccoughs, but it is not as effective as baclofen in treating intractable hiccoughs.
**Clinical Pearl / High-Yield Fact**
Baclofen is a GABA_B receptor agonist that can be used to treat a variety of conditions, including intractable hiccoughs, spasticity, and dystonia. It is a useful medication to know for its unique mechanism of action and its effectiveness in treating a range of neurological conditions.
**Correct Answer:** C. Furosemide