questions 5


Topic updated on 06/07/17 6:29pm

  • A 56-year-old man is brought to the emergency department after being found in the park in a lethargic state. The patient has a history of multiple hospital visits for pain management of acute pancreatitis. Medical history is significant for alcohol use disorder. On physical exam, the patient has slurred speech, nystagmus, and unsteady gait. Laboratory testing is significant for an elevated blood alcohol level. Urine and serum toxicology is negative for illicit drugs. He is started on intravenous thiamine and glucose. Approximately 6 hours after admission the patient becomes nauseous, anxious, tremulous, and develops palpitations. He is subsequently started on intravenous lorazepam. (Alcohol withdrawal)
  • Medications
    • short-acting benzodiazepines
      • alprazolam
      • triazolam
      • oxazepam
      • midazolam
    • longer-acting benzodiazepines
      • flurazepam
      • chlordiazepoxide
      • lorazepam
      • diazepam
  • Mechanism of action
    • ↑ the frequency of Cl- channel opening and thus facilitating GABAA action
      • via its binding to the α and γ subunit of the GABAA receptor
        • this in turn ↓ neuron firing
  • Metabolism
    • oxazepam, temazepam, and lorazepam
      • is not dependent on liver metabolism
  • Adverse reaction
    • dependence
    • can have an additive CNS depressive effect with other CNS depressants (e.g., alcohol and barbiturates)
    • the antidote to benzodiazepine overdose is
      • flumazenil
        • a competitive benzodiazepine receptor antagonist
  • Clinical use
    • anxiety and panic disorder
    • status epilepticus
    • alcohol withdrawal
    • anesthesia premedication
    • sleep walking and other parasomnias
    • skeletal muscle relaxation
    • insomnia


Qbank (2 Questions)

(M1.NE.1) A 15-year-old male sustained a laceration to his left lower extremity (Figure A) during a football game and was stitched up by the EMT later that day. Six days later, the teenager began to experience neck rigidity, laryngospasms, dysphagia, and risus sardonicus. He was taken to the hospital where he was given treatment for an infection caused by a gram-positive, anaerobic bacili that consisted of metronidazole, immunoglobulins targeting the toxoin, and a long-acting medication that facilitates the GABA-A receptor by increasing the frequency of the chloride channel opening. Which of the following medications was he given? Topic Review Topic
FIGURES: A          

1. Triazolam
2. Diazepam
3. Oxazepam
4. Flumazenil
5. Midazolam

(M1.NE.4799) A 61-year-old man presents to the emergency department due to severe malaise. He reports that he began developing tremors, irritability, and severe anxiety approximately 18 hours prior to presentation. He also states that he hears his recently deceased brother speaking to him. Within the past few hours he developed severe nausea and vomited twice. His past medical history is notable for multiple prior hospitalization for acute pancreatitis. He has a 35 pack-year smoking history and drinks multiple alcoholic beverages a day. However, the recent death of his brother motivated him to stop drinking. His temperature is 100.2°F (37.9°C), blood pressure is 150/90 mmHg, pulse is 130/min, and respirations are 22/min. On physical examination, he appears diaphoretic, anxious, and has scleral icterus. Clinical hand findings are shown (Figure A). In addition to fluid resuscitation and vitamin repletion, which of the following would be the best next step in management for this patient? Topic Review Topic
FIGURES: A          

1. Chlordiazepoxide
2. Lactulose
3. Midazolam
4. Rifamixin
5. Lorazepam

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