Which of the following drugs is the choice of treatment in drug-induced anaphylactic shock?

Appeared in: UPRVUNL - 2021

Explanation

Adrenaline is the first-line, life-saving drug for anaphylactic shock.
It acts on alpha and beta-adrenergic receptors to reverse the life-threatening effects of anaphylaxis.
Its alpha-agonist action causes vasoconstriction, increasing blood pressure and reducing airway edema.
Its beta-agonist action causes bronchodilation, opening the airways, and increases heart rate and contractility.

Option A: Protamine Sulphate is an antidote used specifically to reverse the effects of heparin, an anticoagulant.
Option B: Digoxin is a cardiac glycoside used to increase the contractility of the heart muscle in conditions like heart failure and to control the heart rate in atrial fibrillation. It does not address the systemic vasodilation and bronchoconstriction of anaphylaxis.
Option D: Dopamine is a vasopressor, but it is considered a second-line agent in anaphylactic shock. Adrenaline is superior due to its potent and rapid effects on both alpha and beta receptors, which more effectively addresses the pathophysiology of anaphylaxis.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Pharmacological management of anaphylactic shock in acute care settings.
Rapid recognition of anaphylaxis and prompt administration of adrenaline are critical nursing responsibilities that can save a patient's life.
Nurses must be proficient in preparing and administering the correct dose of adrenaline via the intramuscular route, typically in the thigh.
Patient safety is paramount. After administering adrenaline, the nurse must continuously monitor the patient's vital signs and be prepared for further interventions, including repeat doses or advanced airway management.

How to Approach the Question

First, identify the clinical condition presented in the question stem: 'drug-induced anaphylactic shock'. This is a life-threatening emergency.
Recall the first-line, gold-standard treatment for this specific condition. Anaphylaxis requires a drug that can rapidly reverse widespread vasodilation, increased capillary permeability, and bronchoconstriction.
Evaluate each option based on its primary mechanism of action and indication.
Option A (Protamine Sulphate) is a heparin antidote. Option B (Digoxin) is for heart failure/arrhythmias. Option D (Dopamine) is a vasopressor, but second-line to adrenaline in anaphylaxis.
Select the option that directly and most effectively counteracts the pathophysiology of anaphylactic shock. Adrenaline's combined alpha- and beta-adrenergic effects make it the definitive choice.

Concept Tested & Keywords

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E6 Pharmacology Nurses Shanbhag 3e pp. 83-85, 82-84

E6 Pharmacology Nursing Lilley 11e Part 1 p. 318-320

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