American Board of Internal Medicine (ABIM) Certification Practice Exam

How is the administration of IV lorazepam typically followed in treating status epilepticus?

1. By oral midazolam

2. By IV phenytoin or fosphenytoin

3. By administering more lorazepam

4. By monitoring without additional medication

The correct answer is: By IV phenytoin or fosphenytoin

In managing status epilepticus, after the administration of intravenous lorazepam, it is standard practice to follow up with the use of IV phenytoin or fosphenytoin. This step is crucial because lorazepam provides rapid control of seizures, but its effects may not be long-lasting. Phenytoin or fosphenytoin serve as second-line agents that help stabilize the patient's condition and prevent the recurrence of seizures. Phenytoin and fosphenytoin are used because they work differently from benzodiazepines like lorazepam and have a longer duration of action. By transitioning to these medications, clinicians aim to establish a sustained therapeutic level of anticonvulsant effects to prevent additional seizure activity. The other options don’t align with the recommended treatment protocol for status epilepticus after initial treatment with lorazepam. For instance, oral midazolam is not typically used in acute settings when IV access is available and immediate control is necessary. Administering more lorazepam might increase the risk of adverse effects without providing additional benefits, and monitoring without additional medication does not adequately address the risk of ongoing seizures, which is critical in this emergency situation.