A client presents to the healthcare setting with an episode of status epilepticus. Which of the following rescue medications would be utilized in this scenario to assist in stopping the client's seizures?
benztropine (Cogentin)
phenytoin (Dilantin)
diazepam (Valium)
ethosuximide (Zarontin)
The Correct Answer is C
A. Benztropine (Cogentin) is an anticholinergic used primarily for Parkinson's disease and does not have an effect on seizure activity.
B. Phenytoin (Dilantin) is an antiepileptic medication, but it is not typically used as a rescue medication for immediate cessation of seizures in status epilepticus; it is used for long-term management.
C. Diazepam (Valium) is a benzodiazepine that acts quickly to stop seizures and is commonly used in acute situations, including status epilepticus, due to its rapid onset of action.
D. Ethosuximide (Zarontin) is primarily used for absence seizures and is not indicated for status epilepticus.
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Correct Answer is B
Explanation
A. A high first-pass effect means that a significant amount of the drug is metabolized by the liver before reaching systemic circulation, making oral administration less effective.
B. Morphine with a high first-pass effect will be more effective when administered via non-enteral routes, such as IV or subcutaneous, to bypass the liver's initial metabolism.
C. The first-pass effect does not influence the kidney’s rate of excretion but rather the liver’s initial metabolism of the drug.
D. The liver, not the kidneys, is responsible for the first-pass metabolism, which occurs before the drug reaches systemic circulation when taken orally.
Correct Answer is C
Explanation
A. A pulse oximetry of 92% indicates mild hypoxia but does not directly contraindicate the use of verapamil.
B. A respiratory rate of 12 is within the normal range for adults and does not indicate a need to hold the medication.
C. A pulse of 78 is within the normal range but should be assessed in the context of the client’s overall condition; however, if the pulse were significantly lower (e.g., <60 bpm), it would necessitate holding the medication due to the risk of bradycardia.
D. A history of myocardial infarction a week ago would warrant caution but is not an absolute reason to hold verapamil unless other contraindications are present, as verapamil can be beneficial for managing hypertension post-MI.