Emergency Pharmacology Practice Questions

Q: Which of the following conditions can the shown injection be used for emergency management?

Brittle asthma. ***Brittle asthma*** - The image shows an **EpiPen auto-injector**, which contains **epinephrine** (adrenaline). - Epinephrine is a potent **beta-2 agonist** with strong bronchodilatory effects, making it useful in severe acute asthma exacerbations, including **brittle asthma**, when immediate bronchodilation is needed. - While the **primary indication** for EpiPen is anaphylaxis, epinephrine's mechanism (beta-2 receptor stimulation causing bronchodilation, alpha-1 receptor stimulation reducing mucosal edema) provides life-saving relief in severe bronchoconstriction. - In emergency settings with severe asthma unresponsive to standard therapy, subcutaneous or intramuscular epinephrine may be administered. *Hay fever* - Hay fever (allergic rhinitis) involves mild symptoms like sneezing, rhinorrhea, and conjunctival irritation. - Management includes **antihistamines** (e.g., cetirizine, loratadine) and **intranasal corticosteroids** (e.g., fluticasone). - Epinephrine is vastly excessive for routine allergic rhinitis and is reserved only for severe systemic allergic reactions (anaphylaxis). *Snake bite* - Snake bite management centers on **species-specific antivenom** administration plus supportive care (fluid resuscitation, monitoring for coagulopathy, compartment syndrome). - Epinephrine is **not** a primary treatment for envenomation itself. - It may be used only if the patient develops an **anaphylactic reaction to antivenom**, which is a separate indication. *Flushing episodes in carcinoid* - Carcinoid syndrome involves episodic flushing, diarrhea, and bronchoconstriction due to **serotonin, histamine, and vasoactive peptides** released by neuroendocrine tumors. - Treatment involves **somatostatin analogs** (octreotide, lanreotide) which inhibit hormone release from tumor cells. - Epinephrine would not address the underlying mediator release and could potentially worsen hemodynamic instability.

Q: A child with acute lymphoblastic leukemia was given Vincristine in V.A.L.P regimen. However there was an extravasation of the drug. All should be done for management of the same except?

Keep limb dependant. ***Keep limb dependant*** - Keeping the limb dependent will **increase blood flow** and venous congestion at the extravasation site, potentially worsening tissue damage. - The affected limb should be **elevated** to minimize swelling and promote lymphatic drainage. - This is the **INCORRECT** management step. *Aspiration of drug from the extravasated site* - This is an appropriate **immediate step** for managing extravasation. - Use a small syringe to attempt to **withdraw residual drug** from the subcutaneous tissue to minimize further tissue damage. *Apply warm compresses* - **Warmth is recommended** for vinca alkaloid extravasation (vincristine, vinblastine). - Warm compresses promote **vasodilation and drug dispersion**, enhancing absorption and reducing local tissue injury. - Apply for **15-20 minutes several times daily**. *Hyaluronidase injections* - **Hyaluronidase is the specific antidote** for vinca alkaloid extravasation. - It breaks down **hyaluronic acid** in connective tissue, increasing tissue permeability. - This facilitates **dispersion and absorption** of the extravasated drug, thereby reducing tissue necrosis. - Typical dose: **150-900 units subcutaneously** around the extravasation site.

Q: Which of the following statements are correct regarding the use of benzodiazepines in the initial management of status epilepticus? I. Upto two doses may be used 5 minutes apart, if seizures are not controlled II. For Lorazepam, only a single dose should be used, even if seizures are not controlled III. Dose of midazolam at this stage is 1-15 mcg / kg / min infusion IV. Dose of both lorazepam and midazolam is 0.1 mg / kg Select the answer using the code given below :

I and IV. ***I and IV*** - According to current guidelines, **up to two doses** of a benzodiazepine may be administered 5 minutes apart if the **seizures are not controlled** after the initial dose. - The recommended dose for both **lorazepam and midazolam** in the initial management of status epilepticus is **0.1 mg/kg**. *II and IV* - This option is incorrect because statement II is false, as **multiple doses of lorazepam** can be administered if seizures are not controlled. - While statement IV is correct regarding the dosage of lorazepam and midazolam. *I and III* - This option is incorrect because statement III is false, as **1-15 mcg/kg/min infusion** is the dose for **continuous infusion** of midazolam in refractory status epilepticus, not the initial bolus dose. - Statement I is correct but paired with an incorrect statement. *II and III* - This option is incorrect because both statements II and III are false regarding the initial management of status epilepticus. - As previously stated, **multiple doses of lorazepam** can be used, and the given midazolam dose is for **continuous infusion**, not the initial bolus.

Q: What is the antidote for belladonna poisoning?

Physostigmine. ***Physostigmine*** - **Physostigmine** is a **reversible acetylcholinesterase inhibitor** that increases acetylcholine levels at the muscarinic and nicotinic receptors. - This effectively counteracts the **anticholinergic effects** of belladonna, which contains atropine and scopolamine, by overcoming the competitive blockade. *Atropine* - **Atropine** is the primary toxic component in belladonna, acting as a **muscarinic acetylcholine receptor antagonist**. - Administering atropine would worsen the existing anticholinergic toxidrome, making it a contraindicated treatment. *Amitriptyline* - **Amitriptyline** is a **tricyclic antidepressant** and has significant **anticholinergic properties** itself. - Using amitriptyline would exacerbate rather than treat the symptoms of belladonna poisoning due to its similar mechanism of action. *Flumazenil* - **Flumazenil** is an **antagonist of benzodiazepine receptors** and is used to reverse benzodiazepine overdose. - It has no effect on the muscarinic receptor blockade caused by belladonna alkaloids and would not be effective in this poisoning.

Q: What is the drug of choice for emergency contraception ?

Levonorgestrel only pill. ***Levonorgestrel only pill*** - **Levonorgestrel-only pills (LNG-EC)** are the most common and effective form of emergency contraception globally, available over-the-counter in many regions. - It works primarily by **inhibiting or delaying ovulation** and is most effective when taken as soon as possible after unprotected intercourse. *High dose oestrogen alone* - High-dose estrogen alone is **not used** for emergency contraception due to its high incidence of side effects like severe nausea and vomiting. - While estrogens can affect implantation, their use without progestin for EC is **ineffective and unsafe** compared to other methods. *Danazol* - **Danazol** is an attenuated androgen that was explored for emergency contraception but has been largely **abandoned** due to variable efficacy and a high incidence of side effects like androgenic effects. - It works by suppressing ovulation and endometrial development but is **inferior** to levonorgestrel or ulipristal acetate. *Yuzpe regimen (combined oral pill)* - The **Yuzpe regimen** uses a combination of estrogen and progestin from regular oral contraceptive pills, which is **less effective** and has more side effects (nausea, vomiting) than levonorgestrel-only pills. - This method requires taking **two doses 12 hours apart**, making it less convenient than single-dose levonorgestrel.

Q: Which of the following drugs is not used for the emergency (immediate) management of hyperkalaemia?

Injection MgSO4. ***Injection MgSO4*** - Magnesium sulfate is not a direct treatment for hyperkalaemia; its primary use is for conditions like **eclampsia**, **asthma exacerbations**, or **torsades de pointes**. - It does not directly affect potassium levels or cardiac membrane stability in the context of hyperkalaemia. *10% calcium gluconate over 10 min* - **Calcium gluconate** is used for immediate cardioprotection in hyperkalaemia by stabilizing the **cardiac membrane**, thereby reducing the risk of arrhythmias. - It does not lower serum potassium levels but mitigates the dangerous cardiac effects. *Insulin-dextrose* - This combination is an effective treatment for hyperkalaemia as **insulin** drives potassium from the extracellular to the intracellular space. - **Dextrose** is administered concurrently to prevent hypoglycaemia induced by insulin. *Salbutamol nebulisation* - **Beta-2 agonists** like salbutamol promote the uptake of potassium into cells, thus lowering serum potassium levels. - While effective, its action is generally less rapid and potent than insulin-dextrose or calcium gluconate in severe cases.

Q: A patient presented with dizziness, cool clammy skin, pinpoint pupil with blue lips and fingernails suffering from respiratory depression. The patient was producing a pink frothy sputum on coughing. The drug used to reverse the effects is?

Naloxone. ***Naloxone*** - This patient's presentation with **pinpoint pupils**, **respiratory depression**, and **pink frothy sputum** is highly suggestive of **opioid overdose**. - **Naloxone** is a competitive opioid receptor antagonist used specifically to reverse the effects of opioid-induced respiratory depression and central nervous system depression. *Atropine* - **Atropine** is an anticholinergic drug used to treat **bradycardia** and **organophosphate poisoning**. - It would worsen opioid-induced respiratory depression and is not indicated for this presentation. *Physostigmine* - **Physostigmine** is a cholinesterase inhibitor used to reverse the effects of anticholinergic toxicity, such as from **tricyclic antidepressants** or **atropine overdose**. - It would not treat opioid toxicity and could exacerbate some symptoms. *Phentolamine* - **Phentolamine** is an **alpha-adrenergic blocker** primarily used to treat hypertensive crises, particularly those due to **pheochromocytoma** or in extravasation of vasopressors. - It has no role in the management of opioid overdose.

Q: A female was given morphine sulphate during labour for pain but she developed respiratory distress. Which of the following will be the correct antidote?

Naloxone. ***Naloxone*** - **Naloxone** is a pure opioid antagonist that rapidly reverses the effects of **opioid overdose** [1, 3], including **respiratory depression** [2], by competitively binding to opioid receptors [1]. - Its short half-life may necessitate repeated doses, especially with longer-acting opioids like morphine, to prevent recurrence of respiratory depression [1]. *Epinephrine* - **Epinephrine** is an adrenergic agonist used to treat **anaphylaxis** and severe allergic reactions, as it causes **vasoconstriction** and **bronchodilation**. - It is not an antidote for opioid-induced respiratory depression, which primarily results from central nervous system effects rather than allergic reactions. *Pralidoxime* - **Pralidoxime** is a **cholinesterase reactivator** used to treat poisoning by **organophosphates**, which inhibit acetylcholinesterase, leading to cholinergic crisis. - It works by restoring the function of the enzyme, thereby breaking down excess acetylcholine, and is not indicated for opioid overdose. *Atropine* - **Atropine** is an **anticholinergic agent** that blocks muscarinic acetylcholine receptors, used to treat **bradycardia** and **organophosphate poisoning**. - It would not reverse opioid-induced respiratory depression, as it primarily affects the parasympathetic nervous system and does not antagonize opioid receptor effects.

Q: A 55-year-old man presents to the emergency department with acute confusion, visual disturbances, and difficulty breathing. His wife reports he was working with industrial cleaning supplies in an unventilated space. Laboratory analysis reveals severe metabolic acidosis and elevated anion gap. Which of the following antidotes should be administered immediately?

Hydroxocobalamin. ***Hydroxocobalamin*** - The patient's presentation with **acute confusion**, **visual disturbances**, **difficulty breathing**, and exposure to industrial cleaning supplies in an **unventilated space**, along with **severe metabolic acidosis** and an **elevated anion gap**, is highly suggestive of **cyanide poisoning**. - **Hydroxocobalamin** is a preferred antidote for cyanide poisoning because it directly binds to cyanide, forming cyanocobalamin (vitamin B12), which is then safely excreted, without interfering with oxygen transport in the blood. *Flumazenil* - **Flumazenil** is a benzodiazepine receptor antagonist used to reverse the sedative effects of **benzodiazepine overdose**. - The patient's symptoms (confusion, visual disturbances, metabolic acidosis) are not consistent with benzodiazepine overdose. *Fomepizole* - **Fomepizole** is an alcohol dehydrogenase inhibitor used to treat poisoning by **ethylene glycol** and **methanol**. - While both ethylene glycol and methanol poisoning cause severe metabolic acidosis and elevated anion gap, the patient's exposure to industrial cleaning supplies and the specific symptoms of visual disturbances point more directly towards cyanide than these alcohols. *Naloxone* - **Naloxone** is an opioid antagonist used to reverse **opioid overdose**. - The patient's clinical presentation, including metabolic acidosis and exposure history, does not indicate opioid overdose.

Question 1

Which of the following conditions can the shown injection be used for emergency management?

Accepted Answer

Brittle asthma

Answer

Hay fever

Answer

Snake bite

Answer

Flushing episodes in carcinoid

Question 2

A 3-year-old child presents with febrile seizures. All are correct about the route of drug administered except:

Accepted Answer

Press the plunger slowly to give the complete prescribed dose

Answer

Call for help, keep airway open and turn to lateral position

Answer

Use midazolam provided in the plastic vial

Answer

Insert mucosal atomizer device loosely into nostril

Question 3

A child with acute lymphoblastic leukemia was given Vincristine in V.A.L.P regimen. However there was an extravasation of the drug. All should be done for management of the same except?

Accepted Answer

Keep limb dependant

Answer

Aspiration of drug from the extravasated site

Answer

Hyaluronidase injections

Answer

Apply warm compresses

Question 4

Which of the following statements are correct regarding the use of benzodiazepines in the initial management of status epilepticus?
I. Upto two doses may be used 5 minutes apart, if seizures are not controlled
II. For Lorazepam, only a single dose should be used, even if seizures are not controlled
III. Dose of midazolam at this stage is 1-15 mcg / kg / min infusion
IV. Dose of both lorazepam and midazolam is 0.1 mg / kg

Select the answer using the code given below :

Accepted Answer

I and IV

Answer

II and IV

Answer

I and III

Answer

II and III

Question 5

What is the antidote for belladonna poisoning?

Accepted Answer

Physostigmine

Answer

Atropine

Answer

Amitriptyline

Answer

Flumazenil

Question 6

What is the drug of choice for emergency contraception ?

Accepted Answer

Levonorgestrel only pill

Answer

High dose oestrogen alone

Answer

Danazol

Answer

Yuzpe regimen (combined oral pill)

Question 7

Which of the following drugs is not used for the emergency (immediate) management of hyperkalaemia?

Accepted Answer

Injection MgSO4

Answer

10% calcium gluconate over 10 min

Answer

Insulin-dextrose

Answer

Salbutamol nebulisation

Question 8

A patient presented with dizziness, cool clammy skin, pinpoint pupil with blue lips and fingernails suffering from respiratory depression. The patient was producing a pink frothy sputum on coughing. The drug used to reverse the effects is?

Accepted Answer

Naloxone

Answer

Atropine

Answer

Physostigmine

Answer

Phentolamine

Question 9

A female was given morphine sulphate during labour for pain but she developed respiratory distress. Which of the following will be the correct antidote?

Accepted Answer

Naloxone

Answer

Epinephrine

Answer

Pralidoxime

Answer

Atropine

Question 10

A 55-year-old man presents to the emergency department with acute confusion, visual disturbances, and difficulty breathing. His wife reports he was working with industrial cleaning supplies in an unventilated space. Laboratory analysis reveals severe metabolic acidosis and elevated anion gap. Which of the following antidotes should be administered immediately?

Accepted Answer

Hydroxocobalamin

Answer

Flumazenil

Answer

Fomepizole

Answer

Naloxone

Emergency Pharmacology — MCQs

Emergency Pharmacology — MCQs

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