WBR0445
| Author | [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pharmacology |
| Sub Category | SubCategory::Neurology |
| Prompt | [[Prompt::A 28-year-old male is brought to the emergency room for excessive somnolence, impaired balance, and impaired motor function. Suspecting a benzodiazepine overdose, flumazenil is administered at the appropriate dose and infusion rate. A few seconds following the administration of flumazenil, the patient’s wife arrives and explains that her husband attempted suicide by excessively ingesting a benzodiazepine and a tricyclic antidepressant. Which of the following symptoms will the patient most likely experience following the administration of flumazenil?]] |
| Answer A | AnswerA::Seizure |
| Answer A Explanation | AnswerAExp::See explanation. |
| 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 BZDs.]] |
| 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 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 (BZD) is co-ingested with tricyclic antidepressants (TCA, often manifests with seizures, a side effect of tricyclic antidepressants. 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.
As a result a risk-to-benefit ratio in patients must be considered when administering flumazenil. Haverkos GP, DiSalvo RP, Imhoff TE. Fatal seizures after flumazenil administration in a patient with mixed overdose. Ann Pharmacother. 1994;28(12):1347-9.]] |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::benzodiazepine, WBRKeyword::tricyclic antidepressant, WBRKeyword::flumazenil, WBRKeyword::seizure, WBRKeyword::adverse drug reaction, WBRKeyword::side effect, WBRKeyword::congestion, WBRKeyword::mixed overdose, WBRKeyword::suicide |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |