lucky_doc
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an unconscious 24 yo M is brought to a rural urgent care clinic by his family. The patient is cyanotic and has clearly swollen lips and tongue. His mother states that he is extremely allergic to peanuts and the problem developed suddenly at a restaurant next door. The clinic has no supplies to intubate the patient. Which of the following medications is contraindicated for this patient?
A Albuterol
B Diphenhydramine
C Epinephrine
D Labetalol
E Methylprednisolone
F Ranitidine
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| drshvetasm
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D?
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| Ivonne
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Labetalol will decrease blood pressure( alfa-blocker effect) and and bronchoconstriction(b blocker effect) we don't want that...
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| hero
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A
Good questions, doc!
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| Ivonne
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hero wrote:
A
Good questions, doc!
Why?
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| hero
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Ivonne wrote:
Why?
Ipratropium and ipratropium/albuterol metered dose inhalers (Atrovent and Combivent; Boehringer Ingelheim) use soya lecithin, a legume related to peanuts, as a suspending agent. Anaphylactic reactions have occurred in patients with allergies to peanuts or soybeans who have received Atrovent. Soya lecithin is only used in the Atrovent and Combivent inhalers; the nasal spray and nebulized solution do not contain peanut products. (Source: March 2003 Pharmacists’ Letter).
but, you know, your answer is good, just don't know which one is correct.
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| farnsworth
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wow, hero! that was good literature research.
now, give this another thought: the allergic reaction is caused by histamine release from mast cells, mediated via H-receptors. If you administer ranitidine (H2-receptor blocker) you 'shift' the histamine to H1-receptors, aggravating the allergic reaction. This is the reason why you should always give H1-receptor antagonist before administering H2-receptor blockers.
tricky question!
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| Ivonne
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According to this article I can use albuterol for food allergy the only thing that comes up is the fact that they can not intubate there...
The right answer as always is unexpected but the discussion is always fun
http://www.emedicine.com/med/TOPIC806.HTM#section...
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| farnsworth
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if the hospital does not have the supplies for an intubation, then I wouldn't expect them to have epinephrine...
anyway, in a severe case of anaphylaxis I would stay with the drugs you know they really work (epinephrine iv titrated to effect, iv corticosteroids, H1/H2-receptor blockers). When the patient is intubated (avoid thiopental for induction of anesthesia, as well as morphine, both cause further histamine release) or you are going to intubate, you could also give ketamine, which has some bronchodilating effect, eventually you also have to give atropine/glycopyrrulate, to reduce bronchial secretions...
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| lucky_doc
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The answer is D labetalol good explanation guys, keep up the good work
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