Question
A one-year-old boy with febrile seizures was brought to the emergency department. (
- (a) Which is the drug administered and mention the route of administration with its rationale. ( 2 mark(s)
- (b) Write the mechanism of action and other uses of the above drug. ( 2 mark(s)
- (c) Add a note on sodium valproate. 2 mark(s)
Answer
a) Drug, route, and rationale Diazepam, given rectally (or intravenously if IV access is already secured). The rectal route is preferred in the emergency/pre-hospital setting for a convulsing child because it avoids the difficulty and delay of securing IV access in an actively seizing infant, while still giving rapid absorption through the rectal mucosa and fast onset of action.
b) Mechanism of action and other uses Mechanism: diazepam → binds the benzodiazepine site on the GABA-A receptor → enhances GABA-mediated chloride channel opening frequency → neuronal hyperpolarization → anticonvulsant, sedative, and muscle-relaxant effects.
Other uses: status epilepticus, anxiety disorders, skeletal muscle spasm/spasticity, pre-anesthetic medication, alcohol withdrawal, tetanus.
c) Note on sodium valproate Broad-spectrum antiepileptic. MOA: increases GABA levels (inhibits GABA transaminase), blocks voltage-gated Na⁺ channels, and blocks T-type Ca²⁺ channels (useful in absence seizures). Uses: generalized tonic-clonic seizures, absence seizures, myoclonic seizures, febrile seizure prophylaxis, bipolar disorder, migraine prophylaxis. Adverse effects: hepatotoxicity, teratogenicity (neural tube defects — avoided in pregnancy), weight gain, tremor, alopecia, thrombocytopenia.