A 32-year-old woman was brought to the emergency department because of a generalized tonic-clonic seizure. Her husband stated that his wife had been suffering from epilepsy since childhood, but the seizures were only partially controlled by medication. Which of the following pairs of neurotransmitters are thought to be most involved in seizure disorders?

Correct Answer: B

Rationale: The correct answer is B: GABA and glutamate. GABA is an inhibitory neurotransmitter that helps regulate neuronal excitability, while glutamate is an excitatory neurotransmitter that enhances neuronal activity. In seizure disorders, an imbalance between these two neurotransmitters can lead to excessive neuronal firing and seizures. GABAergic drugs are commonly used to increase inhibition and reduce seizure activity. A: GABA and serotonin - While serotonin plays a role in mood regulation and certain aspects of seizure disorders, it is not as directly involved in the mechanisms of seizures as glutamate. C: GABA and acetylcholine - Acetylcholine is involved in various functions such as muscle movement and memory but is not as central to seizure disorders as glutamate. D: Serotonin and glutamate - While both serotonin and glutamate have roles in the central nervous system, glutamate is more directly implicated in seizure disorders compared to serotonin.

Correct Answer: C

Rationale: The correct answer is C: Eszopiclone. Eszopiclone is a non-benzodiazepine hypnotic commonly used to treat insomnia. It is suitable for the 49-year-old woman experiencing difficulty sleeping as it helps initiate and maintain sleep without causing dependence or tolerance issues. Flunitrazepam (A) is a benzodiazepine with high potential for abuse and dependence. Buspirone (B) is an anxiolytic drug, not specifically indicated for insomnia. Fluoxetine (D) is an antidepressant, which may not directly address the sleep issue. Therefore, Eszopiclone is the most appropriate choice for treating the woman's sleep problem.

Correct Answer: C

Rationale: The correct answer is C: Fentanyl and ketamine. Fentanyl is a potent opioid analgesic, while ketamine is a dissociative anesthetic. This combination is commonly used for procedures requiring analgesia and sedation. Fentanyl provides pain relief, and ketamine induces a dissociative state for anesthesia. Thiopental and midazolam (choice D) are both sedatives, not commonly used together. Fentanyl and thiopental (choice A) are both sedatives, but lacking in analgesic effects. Fentanyl and midazolam (choice B) offer sedation and anxiolysis, but lack the dissociative anesthesia provided by ketamine.

Correct Answer: A

Rationale: The correct answer is A: Halothane. Halothane is contraindicated in patients with a history of malignant hyperthermia, a rare but life-threatening condition triggered by certain anesthetics. Using halothane in such patients can lead to a dangerous reaction. Fentanyl (B), Lorazepam (C), and Thiopental (D) do not have the same risk of triggering malignant hyperthermia and are commonly used in anesthesia protocols. Therefore, Halothane is the only drug in the options that would be contraindicated in this scenario.

Correct Answer: C

Rationale: The correct answer is C: Lidocaine. Lidocaine is an amide-type local anesthetic that does not contain PABA, making it suitable for a patient with a history of anaphylactic reaction to PABA. Procaine (A) is an ester-type local anesthetic that metabolizes into PABA. Tetracaine (B) is also an ester-type local anesthetic that may cross-react with PABA. Benzocaine (D) is a para-aminobenzoic acid derivative and should be avoided in patients with a history of anaphylaxis to PABA.