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Here are the answers for the clinical pharmacology practical exam:
Case 14: 37-year-old male, after ceftriaxone administration → lip/eye/tongue swelling, itching, skin redness, difficulty breathing, BP 90/60, HR 100/min.
Station 1 — Diagnosis
Anaphylaxis (severe type I hypersensitivity / IgE-mediated allergic reaction to ceftriaxone)
Station 2 — P-Medication Choice: Epinephrine (Adrenaline)
3. Dosage Form
Injection solution (1:1000 = 1 mg/mL)
4. Dosage
0.3–0.5 mg IM (intramuscular, anterolateral thigh); repeat every 5–15 min if needed
Station 3
5. Pharmacokinetics
- Absorption: Rapid after IM injection
- Distribution: Wide; crosses blood-brain barrier poorly
- Metabolism: Rapidly metabolized by MAO and COMT in liver/tissues
- Elimination: Renal excretion of metabolites; short half-life (~2 min)
6. Mechanism of Action
Epinephrine is a non-selective adrenergic agonist (α1, α2, β1, β2):
- α1: Vasoconstriction → raises BP, reduces mucosal edema
- β1: Increases heart rate and cardiac output
- β2: Bronchodilation, suppresses further mediator release from mast cells
7. Prescription
Epinephrine 1 mg/mL (1:1000) injection
Dose: 0.5 mg IM into anterolateral thigh
Repeat once after 5–15 min if no improvement
8. Duration of Treatment
Single/repeated acute doses until stabilized; observe patient for at least 4–6 hours (risk of biphasic anaphylaxis)
9. Side Effects
- Tachycardia, palpitations, hypertension
- Anxiety, tremor, headache
- Pallor, sweating
- Hyperglycemia
10. Contraindications
No absolute contraindications in anaphylaxis (benefit always outweighs risk).
Relative: Severe hypertension, coronary artery disease, hyperthyroidism — use with caution but do NOT withhold in true anaphylaxis.
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