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{{WBRQuestion | {{WBRQuestion | ||
|QuestionAuthor={{ | |QuestionAuthor= {{SSK}} {{Alison}} (Reviewed by Serge Korjian) | ||
|ExamType=USMLE Step 1 | |ExamType=USMLE Step 1 | ||
|MainCategory=Pharmacology | |MainCategory=Pharmacology | ||
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|MainCategory=Pharmacology | |MainCategory=Pharmacology | ||
|SubCategory=Neurology | |SubCategory=Neurology | ||
|MainCategory=Pharmacology | |||
|MainCategory=Pharmacology | |MainCategory=Pharmacology | ||
|MainCategory=Pharmacology | |MainCategory=Pharmacology | ||
| Line 20: | Line 21: | ||
|MainCategory=Pharmacology | |MainCategory=Pharmacology | ||
|SubCategory=Neurology | |SubCategory=Neurology | ||
|Prompt=A 28-year-old | |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? | ||
|Explanation=[[Flumazenil]] should be used carefully in patients who have a history of | |Explanation=[[Flumazenil]] is a GABA<sub>A</sub> 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. | ||
|AnswerA=Seizure | |AnswerA=Seizure | ||
|AnswerAExp= | |AnswerAExp=The use of flumazenil, when a benzodiazepine (BZD) is co-ingested with TCA, often manifests with seizures. | ||
|AnswerB=Chest pain | |AnswerB=Chest pain | ||
|AnswerBExp=Chest pain is not an adverse effect of | |AnswerBExp=Chest pain is not an adverse effect of flumazenil use in this scenario. | ||
|AnswerC=Excessive sedation | |AnswerC=Excessive sedation | ||
|AnswerCExp= | |AnswerCExp=Flumazenil is expected to reverse the excessive sedation that is caused by benzodiazepines. | ||
|AnswerD=Renal failure | |AnswerD=Renal failure | ||
|AnswerDExp=Renal failure is not an adverse effect of | |AnswerDExp=Renal failure is not an adverse effect of flumazenil use in this scenario. | ||
|AnswerE=Acalculous cholecystitis | |AnswerE=Acalculous cholecystitis | ||
|AnswerEExp=Acalculous cholecystitis is not an adverse effect of | |AnswerEExp=Acalculous cholecystitis is not an adverse effect of flumazenil use in this scenario. | ||
|EducationalObjectives=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. | |||
|References=Spivey WH. Flumazenil and seizures: analysis of 43 cases. Clin Ther. 1992; 14(2):292-305.<br> | |||
Haverkos GP, DiSalvo RP, Imhoff TE. Fatal seizures after flumazenil administration in a patient with mixed overdose. Ann Pharmacother. 1994;28(12):1347-9. | |||
|RightAnswer=A | |RightAnswer=A | ||
|WBRKeyword= | |WBRKeyword=Benzodiazepine, Tricyclic antidepressant, Flumazenil, Seizure, Mixed overdose, Suicide | ||
|Approved=Yes | |Approved=Yes | ||
}} | }} | ||
Latest revision as of 00:35, 28 October 2020
| 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:: |