Topic: Seizure
Subject: Medicine
A 36-year-old male with a history of a seizure disorder is brought to the emergency department with generalized tonic-clonic activity. Emergency medical personnel report this has been ongoing for 20 minutes.
After initial resuscitative measures, the preferred medication in this situation is:
Phenytoin (Dilantin)
Fosphenytoin (Cerebyx)
Naloxone
Lorazepam (Ativan)
Correct Answer :
D. Lorazepam (Ativan)
This patient presents in status epilepticus (SE). Although diazepam has long been an effective treatment, lorazepam has emerged as the preferred agent because of pharmacologic properties that should give it a longer duration of action than diazepam.
>Phenytoin and fosphenytoin are limited by potentially serious adverse effects, such as hypotension.
>Intravenous valproic acid has been shown in a pilot study to be equal to or better than phenytoin in aborting generalized SE, and it has been used in some cases of focal status epilepticus
>In some settings where drug intoxication might be likely, consider also adding naloxone. Note: Suspect subtle status epilepticus or transformed status epilepticus in any patient who does not have improving level of consciousness within 20-30 minutes of cessation of generalized seizure activity.
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