Bacterial resistance to antibiotics can occur with which situations? (Select all that apply)

Choice A reason: Drowsiness is not a systemic effect of inhaled albuterol, a beta-2 agonist. Albuterol stimulates beta-adrenergic receptors, increasing cyclic AMP, which can cause CNS stimulation, not sedation. Drowsiness is more associated with antihistamines or other CNS-depressant drugs, not bronchodilators like albuterol.

Choice B reason: Bradycardia is unlikely with albuterol, which activates beta-2 receptors and, to a lesser extent, beta-1 receptors in the heart, potentially causing tachycardia. Systemic absorption of inhaled albuterol can increase heart rate, not decrease it, as it stimulates sympathetic activity, making this incorrect.

Choice C reason: Heartburn is not a recognized systemic effect of inhaled albuterol. While gastrointestinal irritation may occur with oral beta-agonists, inhaled albuterol has minimal systemic absorption, targeting airway smooth muscle. Its side effects are primarily cardiovascular or neurological, not gastrointestinal, making this an incorrect choice.

Choice D reason: Palpitations are a possible systemic effect of inhaled albuterol due to its beta-adrenergic stimulation. Even with low systemic absorption, albuterol can stimulate cardiac beta-1 receptors, increasing heart rate and causing palpitations. This is a known side effect, particularly in sensitive patients or with overuse.

Choice A reason: The 1 to 5 mcg/mL range is too low for theophylline’s therapeutic effect. Theophylline, a methylxanthine, requires 10-20 mcg/mL to achieve bronchodilation by inhibiting phosphodiesterase and increasing cyclic AMP. Levels below this range are ineffective for asthma or COPD management, risking suboptimal control.

Choice B reason: The 30 to 40 mcg/mL range is toxic for theophylline. Levels above 20 mcg/mL can cause serious side effects like seizures, arrhythmias, or nausea due to its narrow therapeutic index. Therapeutic monitoring ensures levels stay within 10-20 mcg/mL for safe and effective bronchodilation.

Choice C reason: The 50 to 60 mcg/mL range is far above theophylline’s therapeutic range, leading to severe toxicity, including life-threatening arrhythmias or convulsions. Theophylline’s efficacy for airway relaxation occurs at 10-20 mcg/mL, and such high levels are dangerous, requiring immediate intervention to reduce toxicity risks.

Choice D reason: The 10 to 20 mcg/mL range is the targeted therapeutic range for theophylline in adults. Within this range, theophylline inhibits phosphodiesterase, increasing cyclic AMP, promoting bronchodilation, and relieving asthma or COPD symptoms. Monitoring ensures efficacy while minimizing toxicity risks like tachycardia or seizures.