American Board of Family Medicine (ABFM) Practice Exam

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In a patient with beta-blocker use experiencing bronchospasms, what is an appropriate management step?

  1. Intravenous epinephrine

  2. Inhaled albuterol

  3. High-dose corticosteroids

  4. Intramuscular glucagon

The correct answer is: Inhaled albuterol

In a patient experiencing bronchospasm as a result of beta-blocker use, inhaled albuterol is the most appropriate management step. Albuterol is a short-acting beta-agonist that works by selectively stimulating beta-2 adrenergic receptors in the bronchial smooth muscle, leading to bronchodilation. This is particularly beneficial in alleviating bronchospasm. When a patient is on beta-blockers, the use of non-selective beta-agonists is contraindicated, as they can exacerbate bronchospasm. However, inhaled albuterol is a selective agonist that can help relieve symptoms without interacting negatively with the beta-blocker. While intravenous epinephrine and intramuscular glucagon might be contemplated in more severe or systemic reactions, they are generally reserved for acute anaphylaxis or severe bradycardia, respectively, and not specifically indicated for isolated bronchoconstriction caused by beta-blockers. High-dose corticosteroids could play a role in managing underlying inflammation, but they are not immediate bronchodilators and thus not the first line for acute bronchospastic episodes. Therefore, utilizing inhaled albuterol effectively addresses the acute bronchospasm while minimizing risks associated with beta-blockade.