You are called to administer a nebulized albuterol treatment to a 47-year-old female patient that is receiving oxygen via binasal cannula at 2 L/min. Her pretreatment heart rate was recorded at 84 beats/min. You would stop the treatment if the patient's heart rate were to reach which of the following:

Correct Answer: D

Rationale: In this scenario, the correct answer is D) 119 beats/min. When administering nebulized albuterol, it is crucial to monitor the patient's heart rate as it can be a potential side effect of the medication. Albuterol is a beta-2 adrenergic agonist that can lead to tachycardia as a result of its stimulatory effects on beta receptors in the heart. Choosing option D as the threshold to stop the treatment is appropriate because a heart rate of 119 beats/min indicates a significant increase from the baseline heart rate of 84 beats/min. This level of tachycardia can be concerning and may warrant discontinuation of the albuterol treatment to prevent further cardiac complications. Regarding why the other options are incorrect: - Option A) 89 beats/min: This heart rate increase may not be significant enough to warrant stopping the treatment and may not indicate a serious adverse reaction. - Option B) 99 beats/min: While closer to the correct answer, it still may not represent a significant enough increase in heart rate to pose immediate risks. - Option C) 109 beats/min: Similar to B, this heart rate elevation may not be high enough to justify halting the treatment. From an educational perspective, understanding the potential side effects of respiratory medications like albuterol and knowing how to monitor and respond to changes in vital signs is crucial for healthcare providers. This case emphasizes the importance of close monitoring during drug administration to ensure patient safety and well-being.

Correct Answer: C

Rationale: In the context of respiratory drugs and the administration of aerosolized epinephrine, the correct answer is C) Tachycardia. Epinephrine is a sympathomimetic drug that acts on adrenergic receptors in the body. When administered via inhalation, it can stimulate beta-1 adrenergic receptors in the heart, leading to an increase in heart rate or tachycardia. This response is expected due to the drug's pharmacological action. Option A) Laryngospasm is incorrect because epinephrine is actually used to treat laryngospasm due to its ability to reduce airway swelling and improve breathing. Option B) Bronchospasm is also incorrect as epinephrine acts as a bronchodilator, helping to relieve bronchospasm and improve airflow in conditions such as asthma or anaphylaxis. Option D) Bradycardia is incorrect because epinephrine typically causes an increase in heart rate rather than a decrease. Educationally, understanding the expected effects of aerosolized epinephrine is crucial for healthcare professionals, especially those working in settings where respiratory drugs are commonly used, such as emergency medicine or critical care. Knowing the pharmacological actions and potential side effects of medications like epinephrine can help in safe and effective patient care and management.

Correct Answer: B

Rationale: In the context of treating acute severe asthma in an otherwise healthy 27-year-old male, the correct option is B) Nebulized salbutamol. Salbutamol is a short-acting beta agonist that acts quickly to dilate the airways, providing rapid relief of bronchospasm in asthma attacks. This helps to improve airflow and oxygenation in the lungs, making it a suitable choice for acute exacerbations. Intravenous midazolam (option A) is a sedative and would not directly address the bronchoconstriction seen in asthma. Intravenous glucocorticosteroids (option C) are used in the management of asthma exacerbations but typically take longer to exert their effects compared to inhaled bronchodilators like salbutamol. Nebulized salmeterol (option D) is a long-acting beta agonist and is not appropriate for the immediate relief needed in acute severe asthma. Educationally, understanding the appropriate pharmacological management of asthma exacerbations is crucial for healthcare professionals, especially in urgent care settings. Knowing when to use rapid-acting bronchodilators like salbutamol can be life-saving in managing acute respiratory distress. It is important to differentiate between the various drug classes used in asthma management to provide timely and effective interventions for patients experiencing exacerbations.

Correct Answer: A

Rationale: In the administration of fluticasone via a metered dose inhaler, option A is correct because it allows for a reduction in the maintenance dose of oral prednisolone in chronic asthma. Fluticasone is a potent inhaled corticosteroid that helps to reduce inflammation in the airways, thereby decreasing the need for systemic corticosteroids like prednisolone. Option B is incorrect because with proper inhaler technique, the majority of the dose should reach the lungs rather than being swallowed. Option C is incorrect because fluticasone can indeed cause hypothalamo-pituitary-adrenal suppression, especially at high doses. Option D is incorrect as fluticasone actually has a higher systemic bioavailability compared to beclomethasone. Educationally, understanding the correct administration and effects of respiratory drugs like fluticasone is crucial for healthcare providers managing patients with asthma and other respiratory conditions. Proper inhaler technique and knowledge of drug properties can significantly impact patient outcomes and reduce the need for systemic medications with potential side effects.

Correct Answer: D

Rationale: In this question, the correct answer is D) Ephedrine. Ephedrine is a sympathomimetic drug that acts by stimulating adrenergic receptors, leading to bronchodilation. Therefore, it does not induce bronchospasm. A) Pilocarpine is a parasympathomimetic drug that can induce bronchospasm by stimulating muscarinic receptors in the airways, causing constriction. B) Acetylcholine is a neurotransmitter that can also induce bronchospasm by binding to muscarinic receptors in the airways, leading to constriction. C) Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can trigger bronchospasm in individuals with asthma or aspirin-exacerbated respiratory disease (AERD) due to its effect on prostaglandin synthesis. Understanding the effects of different drugs on the respiratory system is crucial in the management of respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). Healthcare professionals need to be aware of which medications can potentially exacerbate bronchospasm in susceptible individuals to ensure safe and effective treatment.