A 30-year-old male experiences continuous generalized tonic-clonic convulsions lasting 8 minutes without regaining consciousness. What is the immediate first-line intravenous medication?
Answer and explanation
Correct answer: A. Intravenous lorazepam
- Step 1: Continuous seizure activity lasting 5 minutes or longer defines convulsive status epilepticus.
- Step 2: The first-line emergent pharmacotherapy to terminate seizure activity is an intravenous benzodiazepine, with lorazepam being the preferred agent.
Answer
Intravenous lorazepam.
Why not the others: Levetiracetam is an effective second-line antiepileptic infused immediately after benzodiazepine administration to prevent seizure recurrence. Oral carbamazepine cannot be administered in an actively seizing patient and takes hours to achieve therapeutic levels. Propofol is a general anesthetic reserved for refractory status epilepticus.
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