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A 44-year-old man is admitted to the intensive care unit because of a hypertensive emergency. He has a history of asthma with his last symptomatic episode occurring about 10 years ago. In the emergency department, his blood pressure was 245/120 mm Hg, and he was given an intravenous dose of enalapril followed by a labetalol infusion. One hour later he had chest tightness and difficulty breathing. On physical examination, he is anxious, tachypneic, and diaphoretic. His blood pressure is 170/95 mm Hg. Expiration is prolonged and wheezing is noted in all lung fields.
In addition to stopping the labetalol drip, which of the following medications should be used to improve his breathing?
( A ) Ipratropium bromide
( B ) Albuterol
( C ) Methylprednisolone
( D ) Epinephrine
( E ) Magnesium sulfate
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cc or ee?
will go with cc
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via excluding other options i think C (bcoz itz one of the drugs used in the treatment of asthma exacer. which helps in relieving acute obstruction ......dont know if itz right or not)
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ACEI or betablocker either can induce a bronchospasm though beta blocker is more likely cause in this case.
Ans. ? methylprednisolone though albuterol is the symptomatic antidote it may worsen the blood pressure. Tricky!
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eee.... i m not sure but one of the attending in india was using it regularly in icu,,,,
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it wont work that well.
reference please
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Labetalol is an α- and β-blocker useful in the management of hypertension. However, in some patients, labetalol has untoward effects. This patient has an exacerbation of asthma precipitated by labetalol. Ipratropium bromide (and atropine) is very effective for the treatment of bronchospasm in this situation. β-Receptors in the tracheobronchial tree inhibit release of acetylcholine from nerve endings. The bronchospasm associated with β-blockers is due to blockade of β-receptors. This leads to uninhibited activation of the cholinergic system resulting in bronchoconstriction. Blocking the cholinergic system with ipratropium bromide is an effective and reliable method for treating bronchoconstriction due to β-blockade.
Intravenous magnesium sulfate is not recommended by the National Asthma Education and Prevention Program published clinical practice guidelines for the treatment of asthma in any setting. In the setting of β-blockade, the efficacy of β-agonists such as epinephrine and albuterol is highly unreliable. Epinephrine will lead to elevation of this patient's blood pressure, and thus is contraindicated. Methylprednisolone acts predominantly by limiting inflammation in the airways and takes at least 4 hours to achieve a response.
