WBR0445
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| Author | [[PageAuthor::Serge Korjian M.D. (Reviewed by Alison Leibowitz) (Reviewed by Serge Korjian)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pharmacology |
| Sub Category | SubCategory::Neurology |
| Prompt | [[Prompt::A 28-year-old man is brought to the emergency department for excessive somnolence and impaired motor function. Suspecting a benzodiazepine overdose, flumazenil is immediately administered. A few seconds following the administration of flumazenil, the patient’s wife arrives to the emergency department and confirms that her husband likely attempted suicide by ingesting a handful of her anxiety pills which include lorazepam and fluoxetine. Which of the following symptoms will the patient most likely experience following the administration of flumazenil?]] |
| Answer A | AnswerA::Seizure |
| Answer A Explanation | AnswerAExp::The use of flumazenil, when a benzodiazepine (BZD) is co-ingested with TCA, often manifests with seizures. |
| Answer B | AnswerB::Chest pain |
| Answer B Explanation | AnswerBExp::Chest pain is not an adverse effect of flumazenil use in this scenario. |
| Answer C | AnswerC::Excessive sedation |
| Answer C Explanation | AnswerCExp::Flumazenil is expected to reverse the excessive sedation that is caused by benzodiazepines. |
| Answer D | AnswerD::Renal failure |
| Answer D Explanation | AnswerDExp::Renal failure is not an adverse effect of flumazenil use in this scenario. |
| Answer E | AnswerE::Acalculous cholecystitis |
| Answer E Explanation | AnswerEExp::Acalculous cholecystitis is not an adverse effect of flumazenil use in this scenario. |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::Flumazenil is a GABAA receptor antagonist used primarily for the treatment of benzodiazepine overdoses. Flumazenil should be used carefully in patients who have a history of seizures, such as epilepsy, or when there is suspicion of a mixed overdose. The use of flumazenil, when a benzodiazepine is co-ingested with tricyclic antidepressants (TCA), often manifests with seizures, a side effect of TCAs. The seizure is not believed to be a side effect of flumazenil itself, rather one of TCAs that occurs when the effect of the benzodiazepine is reversed but that of the TCA is not. Educational Objective: The use of flumazenil, when a benzodiazepine is co-ingested with tricyclic antidepressants (TCA), often manifests with seizures. The seizure is not believed to be a side effect of flumazenil itself, rather one of tricyclic antidepressants that occurs when the effect of a benzodiazepine is reversed. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Benzodiazepine, WBRKeyword::Tricyclic antidepressant, WBRKeyword::Flumazenil, WBRKeyword::Seizure, WBRKeyword::Mixed overdose, WBRKeyword::Suicide |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |