WBR0596

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pharmacology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 62-year-old man, with a significant history of aortic valvulopathy, undergoes a planned prosthetic aortic valve replacement. Following the procedure in the coronary care unit (CCU), the patient begins to seize and is not spontaneously recovering from his state. The physician explains that the patient suffers from an ischemic stroke caused by calcific cerebral embolization during the surgery and promptly prescribes pharmacologic therapy to stop his seizures. The prescribed medication is also indicated in which other condition?]]
Answer A	AnswerA::Acute liver toxicity
Answer A Explanation	AnswerAExp::Acute liver toxicity is a contraindication to the use of benzodiazepines.
Answer B	AnswerB::Acute angle glaucoma
Answer B Explanation	AnswerBExp::Benzodiazepines are contraindicated in acute angle glaucoma. They should be used with caution among patients with open-angle glaucoma.
Answer C	AnswerC::Pregnancy
Answer C Explanation	AnswerCExp::Benzodiazepines are teratogenic (class X), They are contraindicated in pregnancy.
Answer D	AnswerD::Myasthenia gravis
Answer D Explanation	AnswerDExp::Because myasthenia gravis (MG) potentially causes respiratory depression due to involvement of the diaphragm, benzodiazepines are contraindicated in MG due to concerns of possible potentiation of respiratory depression.
Answer E	AnswerE::Restless leg syndrome
Answer E Explanation	AnswerEExp::Benzodiazepines have demonstrated efficacy in improving symptoms among patients with restless leg syndrome.
Right Answer	RightAnswer::E
Explanation	[[Explanation::Benzodiazepines (BZDs), especially lorazepam and less commonly diazepam and midazolam, are indicated in the acute management of seizures and status epilepticus, defined as continuous seizure lasting more than 30 minutes or recurrent seizures without regaining consciousness for more than 30 minutes. While BZDs are administered to acutely manage the seizure, patients should also be administered anticonvulsants (such as phenytoin) to prevent new seizures. Benzodiazepines are generally indicated in anxiety and sleep disorders, mood disorders, restless leg syndrome, and symptomatic improvement of substance withdrawal. They are considered teratogenic and are thus contraindicated in pregnancy. They are also contraindicated in acute liver toxicity, acute angle glaucoma, and myasthenia gravis (potentiation of respiratory depression in myasthenic patients with diaphragmatic involvement). Educational Objective: Benzodiazepines are indicated in the acute management of seizures. They are also generally indicated in the management of anxiety and sleep disorders, mood disorders, restless leg syndrome, and symptomatic improvement of substance withdrawal. References: First Aid 2014 page 493]]
Approved	Approved::No
Keyword	WBRKeyword::Benzodiazepines, WBRKeyword::Seizure, WBRKeyword::Status epilepticus, WBRKeyword::Restless leg syndrome, WBRKeyword::Lorazepam, WBRKeyword::Diazepam, WBRKeyword::Stroke, WBRKeyword::Complication, WBRKeyword::Indication
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Order in Linked Questions	LinkedOrder::