A 60year old male presents with tremors of both hands which are postural, symmetric, high frequency tremors. On examination his pulse rate is 58/mt, neurological examination is normal except for tremors. What is the drug of choice for treatment of this patient?
**Core Concept**
The patient's symptoms are indicative of parkinsonian tremors, which are characterized by postural, symmetric, high-frequency tremors. This type of tremor is often associated with Parkinson's disease, but in this case, it's likely caused by a medication side effect given the patient's normal neurological examination and the presence of bradycardia.
**Why the Correct Answer is Right**
The patient's symptoms are likely caused by beta-blocker overdose, which is a common side effect of non-selective beta-blockers. The combination of postural tremors and bradycardia (pulse rate of 58/mt) is a classic sign of beta-blocker toxicity. The drug of choice for treating this patient would be a beta-agonist, such as isoproterenol, to counteract the effects of the beta-blocker.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because anticholinergics are not the first-line treatment for beta-blocker overdose. While anticholinergics can be used to treat parkinsonian tremors, they are not effective in this case.
**Option B:** This option is incorrect because clonazepam is a benzodiazepine and is not indicated for the treatment of beta-blocker overdose. Benzodiazepines are more commonly used to treat anxiety and seizures.
**Option C:** This option is incorrect because primidone is a medication used to treat essential tremor, not beta-blocker overdose. While primidone can be effective in treating tremors, it is not the correct choice in this scenario.
**Option D:** This option is incorrect because propranolol is actually a non-selective beta-blocker, which is likely the cause of the patient's symptoms.
**Clinical Pearl / High-Yield Fact**
Beta-blocker overdose can present with a wide range of symptoms, including tremors, bradycardia, hypotension, and even cardiac arrest. It's essential to recognize the classic signs of beta-blocker toxicity and treat the patient promptly with a beta-agonist.
**Correct Answer:** C.