A 20-year-old male is brought into the emergency department by his college roommate after having a seizure. His roommate states they were at a party where the patient "took something." The patient has no history of seizures and no significant past medical history. The patient is afebrile with a heart rate of 110 beats/minute and blood pressure of 140/90 mm Hg. On physical examination, he is agitated, and his eyes show nystagmus.
Which of the following medications should he be given to the patient to improve his symptoms?
The correct answer is:
B) Lorazepam
The patient in this vignette has taken phencyclidine. Side effects of phencyclidine intoxication include violence, impulsivity, psychomotor agitation, nystagmus, hypertension, tachycardia, psychosis, delirium, and seizures. The patient in this question has symptoms of hypertension and tachycardia and is presenting after a seizure. Treatment for phencyclidine intoxication includes benzodiazepines and rapid-acting antipsychotics.
Answer choice A: Flumazenil, is incorrect. Flumazenil is used for the treatment of benzodiazepine overdose.
Answer choice C: Methadone, is incorrect. Methadone is used for maintenance treatment of opioid use disorder, for medically supervised opioid withdrawal, and for chronic pain.
Answer choice D: Naltrexone, is incorrect. Naltrexone for treatment of alcohol use disorder and sometimes for opioid use disorder though utility for opioid use disorder is questionable.
Answer choice E: Prochlorperazine, is incorrect. Prochlorperazine is a phenothiazine anti-emetic which acts predominantly by antagonizing D2-dopamine receptors in the midbrain.
Key Learning Point
It is important to know common symptoms of intoxication and withdrawal for psychoactive drugs as well as treatment options. Side effects of phencyclidine intoxication include violence, impulsivity, psychomotor agitation, nystagmus, hypertension, tachycardia, psychosis, delirium, and seizures. Treatment for phencyclidine intoxication includes benzodiazepines and rapid-acting antipsychotics.
