QuestionMultiA
QuestionChoice
33910
c
Azelastine hydrochloride;1 spray;Oral (PO);Twice daily
QuestionChoice
33913
f
Chloroquine;225mg;Nebulised (NEB);Once weekly
QuestionChoice
33911
d
Ibuprofen;200 mg;Oral (PO);8-hourly
QuestionChoice
33908
a
Salbutamol (100 micrograms,dose metered-dose inhaler);200 micrograms;Inhaled (ING);When required
QuestionChoice
33912
e
Dermacort hydrocortisone 0.1% cream;-;Topical;Daily
QuestionChoice
33914
g
Nitrofurantoin;22.5mg;Oral (PO);6-hourly
QuestionChoice
33909
b
Budesonide;200 micrograms;Inhaled (INH);Once daily in evening
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2728
Drug contraindications for G6PD & asthma
Topic
91
Paediatrics
1. Nitrofurantoin is an antibiotic that works by damaging bacterial DNA. Chloroquine is a medication used to prevent and treat malaria. Nitrofurantoin and chloroquine are contra-indicated in patients with G6PD-deficiency because are they known to cause severe haemolytic anaemia.
2. Ibuprofen is known to cause bronchospasm in patients with asthma, especially those with a history of hypersensitivity to aspirin or any other NSAID. Ibuprofen inhibits the activity cyclooxygenase-1 (Cox-1). The inhibition leads to activation of lipoxygenase pathway that in turn increases the release of cysteinyl leukotrienes (Cys-LTs) that induces bronchospasm.
6795
f g
d
Case presentation: A 9-year old boy arrives at A&E with shortness of breath and wheeze. He presented to his GP two days ago with increased urinary frequency and dysuria. A diagnosis of lower urinary tract infection was made and antibiotic treatment was commenced. He has a past medical history of asthma which has so far been well controlled. His weight is 30kg. His mother who is accompanying him informs that the family has just come back from Nigeria and that they have been taking malaria prophylaxis. PH: Asthma, Allergic rhinitis, Eczema, Lower urinary tract infection, vesicoureteral reflux, Glucose-6-phosphate dehydrogenase (G6PD) deficiency DH: Her current regular prescriptions are listed below


**On examination**: Breathing using accessory muscles, polyphonic expiratory wheeze

**Vital signs**: Temperature 36.6°C, HR 90, O2 Sat 92% (room air), RR 26

Question 1: Select the TWO prescriptions that are contra-indicated or should be used with caution in the context of G6PD deficiency (mark them with a tick in column A)
Question 2: Select the ONE prescription that is most likely to have led to exacerbation of asthma symptoms (mark it with a tick in column B)