Complications and emergencies: refractory anaphylaxis on beta-blocker: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Complications and emergencies: refractory anaphylaxis on beta-blocker

Sample item

A patient on long-term metoprolol develops anaphylaxis with severe hypotension and bradycardia that remain refractory to repeated intravenous adrenaline. Which additional drug may overcome the beta-blockade?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Glucagon

Beta-blockers blunt the response to adrenaline in anaphylaxis. Glucagon raises cyclic AMP through glucagon receptors, bypassing the blocked beta receptors, and increases heart rate and contractility. It is given as a bolus followed by an infusion, and vomiting is a common side effect.

Option by option

  • A. Sodium bicarbonate

    Sodium bicarbonate treats acidosis and does not counteract beta-blockade.

  • B. Dobutamine

    Dobutamine is a beta agonist and its action is blunted by the same blockade.

  • C. Glucagon (correct)

    Correct. Glucagon acts through its own receptors to raise cyclic AMP, so it works despite beta-receptor blockade.

  • D. Atropine

    Atropine may raise the heart rate by vagal blockade but does not reverse vasodilatation or restore contractility.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, Glucagon. Beta-blockers blunt the response to adrenaline in anaphylaxis.

Why is "Sodium bicarbonate" not the answer?

Sodium bicarbonate treats acidosis and does not counteract beta-blockade.

Why is "Dobutamine" not the answer?

Dobutamine is a beta agonist and its action is blunted by the same blockade.

Why is "Atropine" not the answer?

Atropine may raise the heart rate by vagal blockade but does not reverse vasodilatation or restore contractility.

What concept does this question test?

It tests Complications and emergencies: refractory anaphylaxis on beta-blocker in Anaesthesia. Glucagon raises cyclic AMP through glucagon receptors, bypassing the blocked beta receptors, and increases heart rate and contractility. It is given as a bolus followed by an infusion, and vomiting is a common side effect.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Complications and emergencies: refractory anaphylaxis on beta-blocker?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.