A 82-year-old woman is seen in the emergency department due to increased headache and abdominal pain. She also vomitted twice and feels nauseated. She has a history of chronic obstructive pulmonary disease and despite taking her medication regulary, her symptoms were worsening for which a thyeophylline is added. Temperature is 37 C (98.6 F), blood pressure is 115/75 mm Hg, pulse is 116/min, and respirations are 23/min. On physical examination, the patient appears agitated and restless. There is a coarse tremor of the outstretched arms. Chest auscultation reveals mild expiratory wheezing. Serum theophylline levels are markedly elevated. Treatment with which of the following agents most likely precipitated this patient's current symptoms?

Question

A 82-year-old woman is seen in the emergency department due to increased headache and abdominal pain. She also vomitted twice and feels nauseated. She has a history of chronic obstructive pulmonary disease and despite taking her medication regulary, her symptoms were worsening for which a thyeophylline is added. Temperature is 37 C (98.6 F), blood pressure is 115/75 mm Hg, pulse is 116/min, and respirations are 23/min.  On physical examination, the patient appears agitated and restless.  There is a coarse tremor of the outstretched arms.  Chest auscultation reveals mild expiratory wheezing.  Serum theophylline levels are markedly elevated.  Treatment with which of the following agents most likely precipitated this patient's current symptoms?

Quizplus · Accepted Answer

Eductional Objective: Theophylline is an adenosine receptor antagonist and indirect adrenergic agent with a narrow therapeutic index.  It is predominantly metabolized by the hepatic cytochrome oxidases.  Inhibition of these enzymes by concurrent illness (eg, infection with fever) or ingestion of certain drugs or substances (eg, ciprofloxacin) can raise serum theophylline concentrations and cause toxicity (eg, seizures, cardiac arrhythmias)

A 82-Year-Old Woman Is Seen in the Emergency Department Due