The Nurse administrated ceftriaxone intravenously to a patient without doing sensitivity testing. Soon patient developed respiratory distress, hypotension, tachycardia, flushing and weal. The drug of choice would be?

1. A

   Histamine

2. B

   Corticosteroid

3. C

   Adrenaline

4. D

   Atropine

Appeared in: RML Lucknow - 2021

Explanation

• The patient's symptoms (respiratory distress, hypotension, tachycardia, flushing, weal) are classic signs of anaphylaxis, a life-threatening allergic reaction.
• Adrenaline (epinephrine) is the first-line drug of choice for anaphylaxis.
• Its rapid alpha- and beta-adrenergic actions reverse the life-threatening effects of the reaction: it causes vasoconstriction to increase blood pressure, bronchodilation to open the airways, and increases cardiac output.
• The administration of adrenaline should not be delayed for any reason, as it is the most critical life-saving intervention.

Why Other Options Were Wrong

• Option A: Histamine is a primary chemical mediator released from mast cells during an anaphylactic reaction. It is the cause of many of the symptoms (vasodilation, bronchoconstriction). Administering more histamine would worsen the patient's condition.
• Option B: Corticosteroids have a slow onset of action, typically taking several hours to become effective. They are not useful for the immediate management of life-threatening symptoms like hypotension and bronchospasm.
• Option D: Atropine is an anticholinergic drug used to treat symptomatic bradycardia (a slow heart rate). This patient is experiencing tachycardia (a fast heart rate), so administering atropine would be inappropriate and potentially harmful.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Management of Anaphylaxis to guide bedside assessment, documentation, and the next nursing action.
• Immediate recognition of anaphylaxis and prompt administration of intramuscular adrenaline are critical nursing responsibilities that can save a patient's life.
• Nurses must always be prepared for potential allergic reactions when administering new medications, especially antibiotics like penicillins and cephalosporins. This includes knowing the location of emergency equipment and adrenaline.
• What if? If the patient was taking a beta-blocker medication (e.g., metoprolol), they might have a more severe and prolonged anaphylactic reaction that is resistant to adrenaline. In this case, glucagon may be required as it can increase heart rate and contractility via a non-adrenergic pathway.

How to Approach the Question

• First, analyze the clinical scenario to identify the patient's condition. The rapid onset of respiratory distress, hypotension, tachycardia, and skin changes after IV drug administration points directly to anaphylaxis.
• Next, recall the standard emergency management protocol for this life-threatening condition.
• The question asks for the 'drug of choice,' which implies the first-line, most critical medication.
• Evaluate each option based on its role in treating anaphylaxis.
• Adrenaline (epinephrine) is the known first-line agent that directly reverses the life-threatening pathophysiology.
• Eliminate the other options: Histamine is the cause, not the cure. Corticosteroids are too slow for immediate relief. Atropine is for bradycardia, not tachycardia.

Concept Tested & Keywords

• Concept Tested: Management of Anaphylaxis
• Stem keywords: ceftriaxone, intravenously, respiratory distress, hypotension, tachycardia, flushing, weal
• Lead-in keywords: drug of choice
• Clinical cues: The combination of respiratory distress, hypotension, and skin manifestations (flushing, weal) immediately after drug administration is the classic presentation of anaphylaxis.

Question ID

Q2WBG0c-2h_2ff4PCXYueb

Copy ID

Reference Book

E6 Pharmacology KD Tripathi OneStop 9e p. 139-141

E6 Pharmacology Katzung 16e p. 1548-1550

E6 Pharmacology Nurses Shanbhag 3e p. 33-35