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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{YD}} (Reviewed by  {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pharmacology
|MainCategory=Pharmacology
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|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Pulmonology
|SubCategory=Pulmonology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
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|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Pulmonology
|SubCategory=Pulmonology
|Prompt=An 8 year old boy, with a past medical history of asthma, is brought to the emergency department (ED) for seizures, severe abdominal pain, and vomiting. Upon further questioning, his parents explain that they traveled to USA only one day before admission, and a new asthma medication has been very recently prescribed by a physician abroad. His vital signs are remarkable for tachycardia and tachypnea. Work-up shows major electrolyte disturbances, including hypokalemia, hypophosphatemia, hypomagnesemia, and hypocalcemia. The ED physician explains to the parents that the patient must have been taken very high doses of his asthma medication. Which of the following medications should be prescribed to reverse the patient's condition?
|Prompt=An 8-year-old boy recently diagnosed with asthma is brought to the emergency department (ED) for seizures, severe abdominal pain, and vomiting. Upon further questioning, his parents explain that they traveled to USA only one day prior to admission, and the boy has been prescribed an anti-asthma drug by a physician abroad. The boy's vital signs are remarkable for tachycardia and tachypnea. Work-up demonstrates major electrolyte disturbances, including hypokalemia, hypophosphatemia, hypomagnesemia, and hypocalcemia. The ED physician explains to the parents that the patient must have been receiving very high doses of his anti-asthma drug. Which of the following pharmacologic agents is recommended to reverse this patient's condition?
|Explanation=The patient is presenting with signs and symptoms consistent with theophylline toxicity due to overdose in his theophylline, which is used to treat his asthma. Theophylline induces the release of catecholamines to stimulate the B-adrenergic receptors. It causes systemic symptoms, such as seizures, vomiting, abdominal pain, marked tachycardia, and electrolyte disturbances, such as those observed in the patient in the vignette. The final outcome in severe overdose is cardiovascular collapse and death. B-blockers are used as antidotes for management of theophylline toxicity. Esmolol, a beta-1-selective adrenergic receptor antagonist with a short duration of action, is has been used in emergency situations as a choice of B-blockers.
|Explanation=The patient is presenting with signs and symptoms consistent with theophylline toxicity following theophylline overdose. Theophylline induces the release of catecholamines to stimulate the B-adrenergic receptors. It causes systemic symptoms, such as seizures, vomiting, abdominal pain, marked tachycardia, and electrolyte disturbances, such as those observed in the patient. The final outcome in severe overdose is cardiovascular collapse and death. B-blockers are used as antidotes for the management of theophylline toxicity. Esmolol, a beta-1-selective adrenergic receptor antagonist with an ultrashort duration of action and a short half-life (9 min), is has been used in emergency situations as the B-blocker of choice for theophylline toxicity. Other B-blockers that may be administered in theophylline toxicity include either metoprolol or propranolol.
|AnswerA=Esmolol
|AnswerA=Esmolol
|AnswerAExp=Esmolol is a beta-blocker that is effective for theophylline toxicity.
|AnswerAExp=Esmolol is a beta-blocker that is effective for the management of theophylline toxicity.
|AnswerB=Nicardipine
|AnswerB=Nicardipine
|AnswerBExp=Nicardipine is a calcium channel blocker that is not usually used as antidote.
|AnswerBExp=Nicardipine is a calcium channel blocker that is not usually used in cases of theophylline toxicity.
|AnswerC=Glucagon
|AnswerC=Glucagon
|AnswerCExp=Glucagon may be used as antidote for beta-blocker toxicity.
|AnswerCExp=Glucagon is the antidote for beta-blocker toxicity.
|AnswerD=Flumazenil
|AnswerD=Flumazenil
|AnswerDExp=Flumazenil may be used as antidote for benzodiazepine toxicity.
|AnswerDExp=Flumazenil is the antidote for benzodiazepine toxicity.
|AnswerE=Atropine
|AnswerE=Atropine
|AnswerEExp=Atropine may be used as antidote for organophosphate and acetylcholinesterase inhibitor toxicity.
|AnswerEExp=Atropine is the antidote for organophosphate and acetylcholinesterase inhibitor toxicity.
|EducationalObjectives=Esmolol, an ultrashort acting beta-1-selective blocker, is recommended to reverse theophylline toxicity.
|References=Kempf J, Rusterholtz T, Ber C, et al. Haemodynamic study as guideline for the use of beta blockers in acute theophylline poisoning. Intensive Care Med. 1996; 22:585-587.
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=esmolol, beta, blocker, blockers, theophylline, overdose, toxicity, vomiting, abdominal, pain, seizure, adrenergic, receptor, antagonist, antagonism
|WBRKeyword=Esmolol, Beta blocker, Theophylline overdose, Theophylline toxicity, Vomiting, Abdominal pain, Seizure, Antidote, Reversal agent
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 01:23, 28 October 2020

 
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology
Sub Category SubCategory::Pulmonology
Prompt [[Prompt::An 8-year-old boy recently diagnosed with asthma is brought to the emergency department (ED) for seizures, severe abdominal pain, and vomiting. Upon further questioning, his parents explain that they traveled to USA only one day prior to admission, and the boy has been prescribed an anti-asthma drug by a physician abroad. The boy's vital signs are remarkable for tachycardia and tachypnea. Work-up demonstrates major electrolyte disturbances, including hypokalemia, hypophosphatemia, hypomagnesemia, and hypocalcemia. The ED physician explains to the parents that the patient must have been receiving very high doses of his anti-asthma drug. Which of the following pharmacologic agents is recommended to reverse this patient's condition?]]
Answer A AnswerA::Esmolol
Answer A Explanation AnswerAExp::Esmolol is a beta-blocker that is effective for the management of theophylline toxicity.
Answer B AnswerB::Nicardipine
Answer B Explanation AnswerBExp::Nicardipine is a calcium channel blocker that is not usually used in cases of theophylline toxicity.
Answer C AnswerC::Glucagon
Answer C Explanation AnswerCExp::Glucagon is the antidote for beta-blocker toxicity.
Answer D AnswerD::Flumazenil
Answer D Explanation AnswerDExp::Flumazenil is the antidote for benzodiazepine toxicity.
Answer E AnswerE::Atropine
Answer E Explanation AnswerEExp::Atropine is the antidote for organophosphate and acetylcholinesterase inhibitor toxicity.
Right Answer RightAnswer::A
Explanation [[Explanation::The patient is presenting with signs and symptoms consistent with theophylline toxicity following theophylline overdose. Theophylline induces the release of catecholamines to stimulate the B-adrenergic receptors. It causes systemic symptoms, such as seizures, vomiting, abdominal pain, marked tachycardia, and electrolyte disturbances, such as those observed in the patient. The final outcome in severe overdose is cardiovascular collapse and death. B-blockers are used as antidotes for the management of theophylline toxicity. Esmolol, a beta-1-selective adrenergic receptor antagonist with an ultrashort duration of action and a short half-life (9 min), is has been used in emergency situations as the B-blocker of choice for theophylline toxicity. Other B-blockers that may be administered in theophylline toxicity include either metoprolol or propranolol.

Educational Objective: Esmolol, an ultrashort acting beta-1-selective blocker, is recommended to reverse theophylline toxicity.
References: Kempf J, Rusterholtz T, Ber C, et al. Haemodynamic study as guideline for the use of beta blockers in acute theophylline poisoning. Intensive Care Med. 1996; 22:585-587.]]

Approved Approved::Yes
Keyword WBRKeyword::Esmolol, WBRKeyword::Beta blocker, WBRKeyword::Theophylline overdose, WBRKeyword::Theophylline toxicity, WBRKeyword::Vomiting, WBRKeyword::Abdominal pain, WBRKeyword::Seizure, WBRKeyword::Antidote, WBRKeyword::Reversal agent
Linked Question Linked::
Order in Linked Questions LinkedOrder::