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USMLE STEP 2 Question of the Day 6
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Subscribe for daily Step 2 questions and more medical education content! • Correct Answer: D. Lorazapam • Topic: Psychology/Pharmacology • Explanation: When selecting a benzodiazepine for a patient with liver damage, it is crucial to consider the drug's metabolism and how it might affect the liver. Benzodiazepines that are metabolized by the liver and produce active metabolites can accumulate in patients with liver dysfunction, potentially leading to increased sedation and toxicity. • Here are the options and their relevance to liver metabolism: • A. Chlordiazepoxide: This benzodiazepine is extensively metabolized by the liver and has active metabolites. It is not the best choice for patients with liver damage. • B. Alprazolam: This benzodiazepine is also metabolized by the liver and produces active metabolites. It should be used cautiously in patients with liver damage. • C. Diazepam: Like chlordiazepoxide, diazepam is metabolized in the liver and has long-acting active metabolites. It is not ideal for patients with liver impairment. • D. Lorazepam: This benzodiazepine is unique because it is primarily metabolized by conjugation rather than by the hepatic cytochrome P450 system, which makes it less dependent on liver function. It has a relatively short half-life and does not produce active metabolites that could accumulate and cause adverse effects in patients with liver damage. • Therefore, D. Lorazepam is the preferred choice for a patient with liver damage needing alcohol detoxification because it is less likely to cause additional liver strain and is safer to use in such patients. • The mnemonic ALOT is used to remember the benzodiazepines that are safer to use in patients with liver impairment due to their metabolism primarily by conjugation rather than by the hepatic cytochrome P450 system. These benzodiazepines are: • A: Alprazolam • L: Lorazepam • O: Oxazepam • T: Temazepam • These benzodiazepines are less likely to accumulate in patients with liver dysfunction, making them safer options in such cases. However, it's important to note that while alprazolam is included in this mnemonic, it is actually metabolized by the liver and produces active metabolites, which might not make it the best choice for all patients with significant liver impairment. Lorazepam, oxazepam, and temazepam are more reliably used in these scenarios. • • Tags: #usmlestudents #usmle #step1 #step1prep #step2 #nbme #usmleprep #usmlepreparation #usmlestep1review #usmlestep #usmleexams #med #meded #medicalschool #medicaleducation #medicalexam #medical #medicalstudent #questionoftheday #qotd #qbank #freestepstudying #viralreels #viralshorts #viralshortvideo #psychology #pharmacology #benzos #benzodiazapines #liver #hepatology #alcoholusedisorder #seizures #alcoholwithdrawl
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