PSA Emergency Prescribing 2 — Questions and Answers
Question 1: A 25-year-old develops anaphylaxis after a bee sting with urticaria, hypotension, and bronchospasm. What is the first-line treatment?
- Epinephrine 0.3mg IM (1:1,000 solution) (Correct answer)
- Diphenhydramine 50mg IV push
- Methylprednisolone 125mg IV
- Epinephrine 0.5mg IV (1:10,000 solution)
Correct answer: Epinephrine 0.3mg IM (1:1,000 solution)
IM epinephrine (1:1,000) 0.3–0.5mg into the anterolateral thigh is the first-line treatment for anaphylaxis.
Question 2: A patient with acute severe asthma fails to improve with repeated salbutamol and ipratropium nebulizers plus IV corticosteroids. What IV medication should be added next?
- Magnesium sulfate 2g IV over 20 minutes (Correct answer)
- Aminophylline 5mg/kg IV over 30 minutes
- Ketamine 1mg/kg IV bolus
- Epinephrine 1mg IV bolus
Correct answer: Magnesium sulfate 2g IV over 20 minutes
IV magnesium sulfate 2g over 20 minutes is recommended for acute severe asthma refractory to initial bronchodilators due to its smooth muscle relaxant properties.
Question 3: A patient has had two doses of IV lorazepam 4mg for status epilepticus without cessation of seizures. Which drug is most appropriate as second-line therapy?
- Levetiracetam 60mg/kg IV (max 4.5g) (Correct answer)
- Phenobarbital 20mg/kg IM
- Haloperidol 5mg IV
- Midazolam 10mg IV bolus
Correct answer: Levetiracetam 60mg/kg IV (max 4.5g)
Levetiracetam IV is a preferred second-line agent for benzodiazepine-refractory status epilepticus due to its efficacy and favorable safety profile.
Question 4: A patient has a hypertensive emergency (BP 230/140 mmHg) with acute pulmonary edema. Which agent provides the safest, most titratable blood pressure reduction?
- Nicardipine IV infusion starting at 5mg/hr (Correct answer)
- Sublingual nifedipine 10mg
- Lisinopril 10mg PO
- Oral labetalol 200mg
Correct answer: Nicardipine IV infusion starting at 5mg/hr
IV nicardipine infusion allows precise, titratable blood pressure reduction essential in hypertensive emergencies with end-organ damage.
Question 5: A patient develops acute pulmonary edema with severe respiratory distress and an SpO2 of 82%. Which diuretic dose and route provides the fastest relief?
- Furosemide 40–80mg IV bolus (Correct answer)
- Furosemide 80mg PO
- Hydrochlorothiazide 25mg PO
- Torsemide 20mg PO
Correct answer: Furosemide 40–80mg IV bolus
IV furosemide provides rapid diuresis and immediate venodilation, making it far superior to oral formulations in acute pulmonary edema.
Question 6: A patient calls 911 for crushing chest pain. EMS confirms STEMI. Which antiplatelet should be administered immediately, regardless of reperfusion strategy?
- Aspirin 325mg chewed and swallowed (Correct answer)
- Clopidogrel 600mg PO loading dose
- Ticagrelor 180mg PO
- Warfarin 5mg PO
Correct answer: Aspirin 325mg chewed and swallowed
Aspirin 325mg chewed immediately inhibits platelet thromboxane A2 and is the universal first antiplatelet in STEMI.
Question 7: A 70kg patient with septic shock receives a 30mL/kg NS bolus but remains hypotensive (MAP 52 mmHg). What is the next step?
- Start norepinephrine IV infusion to target MAP ≥65 mmHg (Correct answer)
- Give a second 30mL/kg bolus immediately
- Start dopamine at 5mcg/kg/min
- Administer albumin 25% 100mL IV
Correct answer: Start norepinephrine IV infusion to target MAP ≥65 mmHg
Norepinephrine is the first-line vasopressor for septic shock when fluid resuscitation fails to restore adequate mean arterial pressure.
PSA Emergency Prescribing 2
A 25-year-old develops anaphylaxis after a bee sting with urticaria, hypotension, and bronchospasm.
What is the first-line treatment?