A 56-year-old man presenting with

pulmonary embolism is administered drug A and drug B, as part of his

anti-coagulation treatment. Both drugs are highly bound to albumin (>95%)

and were administered at dosages that saturate albumin binding sites.

Therapeutic levels of “free” drug for both medications have attained

steady-state plasma concentrations.

If drug B is suddenly

discontinued, what is the most likely immediate outcome on drug A?

Epinephrine is a hormone

that can reverse many effects of histamine, although it does not act on any

histamine receptor and has no effect on histamine’s metabolism.

What type of antagonist is

epinephrine to histamine?

A 20-year-old medical student was diagnosed with

asthma 8 years ago. The number of episodes of severe bronchospasm has increased

recently, and the clinician has been asked to review the therapeutic plan.

Which agent is most likely to be of immediate

therapeutic value during an acute bronchospastic attack and what is its mode of

action?

A 50-year-old man has been a

heavy smoker for the last 20 years. 

Smoking can induce specific hepatic enzymes, such as CYP1A2. Verapamil (flow-limited) and phenytoin (capacity-limited) are both eliminated from the body by metabolic degradation catalysed

by some of the induced enzymes. Verapamil has a clearance of 1.5 L/min,

approximately equal to liver blood flow, whereas phenytoin has a clearance of

0.1 L/min.

What will be the effects of

smoking on both verapamil and phenytoin?

A 30-year-old male requires regular

monitoring of plasma concentration of drug A. At 6 h after intravenous

administration of a loading dose, the plasma level of drug A is 10 mg/L. The Vd

is 5 L and the elimination half-life is 3 h.

Based on this information, what was

the dose administered initially?

A 41-year-old man was admitted to the

hospital after he suffered a seizure with loss of consciousness while at home.

Two weeks earlier, the man was involved in a car accident and had suffered from

a closed head injury. A neurologic examination and an electroencephalogram led

to the discovery of an epileptic focus in the patient’s temporal lobe. The

neurologist ordered an anticonvulsant drug that most likely acts with multiple

mechanisms, including blockade

of T-type Ca

Which drug was most likely prescribed?

A 37-year-old man

was brought unconscious to the Emergency Department. His respiratory rate is low. 

Which drug most

likely contributed to the patient’s intoxication?

A 45-year-old man is being treated

prophylactically with propranolol, following an episode of myocardial

infraction. The patient also has a past medical history of another condition.

Which condition may concern you

regarding the use of this drug in this patient?

A 6-year-old boy who was playing

in the garden earlier was stung by 3 bees. He had a previous history of bee

sting allergy so he was brought to the Emergency Department, where he was

diagnosed with anaphylaxis.

What is the treatment of choice for this patient?

An army base was under attack

with a nerve gas. The soldiers exhibited symptoms including skeletal muscle

paralysis, profuse bronchial secretions, miosis, bradycardia and convulsions.

These suggest exposure to an organophosphate.

What would be the most appropriate

immediate management?