Which reversal agent should be on standby when administering lorazepam for status epilepticus?

• A. Narcan
• B. Flumazenil
• C. Calcium Chloride
• D. Idarucizumab

Answer: (B)

When you’re treating status epilepticus with lorazepam, have a benzodiazepine reversal ready because you may need to reverse excessive sedation or respiratory depression. The reversal agent is flumazenil, which is a competitive antagonist at the benzodiazepine binding site on the GABA-A receptor. By blocking the benzodiazepine effect, it rapidly reverses CNS and respiratory depression caused by lorazepam. Use of flumazenil requires caution: it can precipitate seizures in people who are benzodiazepine-dependent or who have mixed overdoses, and it can cause withdrawal in dependent patients, so it should be used in a setting where airway support and resuscitation are available and with careful dosing. The other agents listed reverse different substances (for example, opioids or anticoagulants) and are not appropriate to counteract the effects of benzodiazepines.