A nurse administered ceftriaxone intravenously to a patient without doing a sensitivity test. The patient developed respiratory distress, hypotension, tachycardia, flushing, and weakness. The drug of choice would be?

1. A

   Hydrocortisone

2. B

   Corticosteroid

3. C

   Adrenaline

4. D

   Atropine

Appeared in: RML 2023

Explanation

• The patient's symptoms (respiratory distress, hypotension, tachycardia) are hallmark signs of anaphylactic shock, a medical emergency.
• Adrenaline (epinephrine) is the first-line, life-saving drug for anaphylaxis due to its rapid onset of action.
• It acts on alpha and beta-adrenergic receptors to cause vasoconstriction (reversing hypotension) and bronchodilation (reversing respiratory distress).
• Its effects are immediate, making it the priority intervention to stabilize the patient and prevent cardiovascular collapse.

Why Other Options Were Wrong

• Option A: Hydrocortisone is a corticosteroid with a slow onset of action (hours). It is not effective for the immediate, life-threatening symptoms of anaphylaxis.
• Option B: Corticosteroids as a class have a slow onset of action and are not the primary treatment for acute anaphylactic shock.
• Option D: Atropine is an anticholinergic drug used to treat bradycardia (slow heart rate). This patient has tachycardia (fast heart rate) as a compensatory response to hypotension.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Management of Anaphylactic Shock to guide bedside assessment, documentation, and the next nursing action.
• Nurses must be able to rapidly recognize the signs of anaphylaxis, as immediate intervention is critical to prevent death.
• The nurse's first actions are to stop the causative agent, call for help, and prepare to administer adrenaline.
• This scenario highlights the importance of performing a test dose before administering drugs known to cause hypersensitivity reactions, such as penicillins and cephalosporins, as per institutional policy.

How to Approach the Question

• First, analyze the clinical scenario. Note the administration of a drug (ceftriaxone) followed by acute symptoms.
• Identify the pattern of symptoms: respiratory distress (airway/breathing problem) and hypotension/tachycardia (circulation problem). This combination points to a systemic, life-threatening reaction.
• Recognize this clinical picture as anaphylactic shock.
• Recall the emergency management protocol for anaphylaxis. The absolute priority is a drug that acts rapidly to reverse bronchoconstriction and hypotension.
• Evaluate the options based on their mechanism and speed of action. Adrenaline is the only option that provides immediate vasoconstriction and bronchodilation.
• Differentiate between first-line (adrenaline) and second-line (corticosteroids, antihistamines) treatments to select the correct 'drug of choice' for the acute phase.

Concept Tested & Keywords

• Concept Tested: Management of Anaphylactic Shock
• Stem keywords: ceftriaxone, sensitivity test, respiratory distress, hypotension, tachycardia, flushing, weakness
• Lead-in keywords: drug of choice
• Clinical cues: The combination of respiratory distress and hypotension after drug administration is a classic sign of anaphylaxis.

Question ID

QMpIuQ_e2t8qhxicvkeanl

Copy ID

Reference Book

E6 Pharmacology KD Tripathi OneStop 9e pp. 139-141, 64-66