Intravenous sedation

Question 1

What is the brand name for Midazolam?

Answer 1

Hypnovel

Question 2

What is the brand name for Propofol?

Answer 2

Diprivan

Question 3

What is the brand name for flumazenil?

Answer 3

Annexate

Question 4

What is the half life of midazolam?

Answer 4

1.5 - 2.5 hours

Question 5

What is the half life of flumazenil?

Answer 5

50 minutes

Question 6

What is the initial recommended bolus of midazolam to ASA I patients?

Answer 6

2mg over 30 seconds

Question 7

What is the initial recommended bolus of midazolam to elderly patients?

Answer 7

1 - 1.5mg, observe for 2 minutes+

Question 8

Name 3 side effects of midazolam

Answer 8

Respiratory depression
Coughing
Headaches & drowsiness
Nausea & vomiting

Question 9

If midazolam is used in conjunction with an opiate, which drug should be administered first?

Answer 9

Opiate

Question 10

What is the pH of midazolam?

Answer 10

3.4

Question 11

Name the 3 dosages that midazolam is available in

Answer 11

10mg in 5ml
10mg in 2ml
5mg/5ml

Question 12

When did midazolam first become available in the UK?

Answer 12

1983

Question 13

What should NOT be administered to a patient experiencing anaphylaxis from midazolam?

Answer 13

Flumazenil - It is a benzodiazepine like midazolam, therefore it should not be used as a reversal drug if someone is allergic to benzodiazepines

Question 14

What is the onset time of midazolam?

Answer 14

1 - 3 minutes

Question 15

Midazolam should be titrated in ___ mg increments

Answer 15

0.5 - 1mg increments

Question 16

What does GABA stand for?

Answer 16

Gamma Amino Butyric Acid

Question 17

How many phases are there in intravenous sedation?

Answer 17

4 Phases

Question 18

What drug is not licenced for use in general dental practices?

Answer 18

Propofol

Question 19

What emulsion is propofol available in?

Answer 19

200mg/20ml

Question 20

Midazolam is excreted by the ___ ?

Answer 20

Kidney

Question 21

What is the maximum dose of flumazenil that can be administered in a medical emergency?

Answer 21

1mg

Question 22

When two or more drugs are used in conjunction together, what is this known as?

Answer 22

Advanced sedation

Question 23

Why is erythromycin contraindicated in midazolam use?

Answer 23

It inhibits the metabolism of midazolam, increasing it’s effect

Question 24

What is the alpha half life of midazolam?

Answer 24

4 - 18 minutes

Question 25

What is the beta half life of midazolam?

Answer 25

1 - 4 hours

Question 26

What does alpha half life relate to?

Answer 26

How the drug is redistributed throughout the body

Question 27

What does the beta half life relate to?

Answer 27

How the drug is eliminated from the body

Question 28

What is the recovery time for Propofol?

Answer 28

5 minutes

Question 29

What is the half life of flumazenil?

Answer 29

50 minutes

Question 30

What is the half life of Propofol?

Answer 30

2 - 24 minutes

Question 31

What is the reversal drug for fentanyl?

Answer 31

Naloxone Hydrochloride

Question 32

What is the dosage for ketamine?

Answer 32

1-2mg per kg IV

Question 33

If midazolam and Propofol are used together, what will you need?

Answer 33

A dedicated sedationist

Question 34

What are 3 contraindications to flumazenil?

Answer 34

Benzodiazepine dependence Coronary heart disease - Stress of reversal places unnecessary stress on the heart Epilepsy - most epilepsy medication belongs to the benzodiazepine family, therefore flumazenil will reverse their epilepsy medication

Question 35

What schedule controlled drug is Propofol?

Answer 35

Schedule IV (4) therefore should be under lock and key

Question 36

Name 3 contraindications for Propofol

Answer 36

Prescribed respiratory depressants Pregnancy & nursing mothers Allergy to eggs

Question 37

What is beta half life?

Answer 37

Metabolism and excretion - drug is broken down by the body and eliminated

Question 37

What is alpha half life?

Answer 37

Distributions and redistribution - the drug is introduced into the body and redistributed throughout

Question 38

After how long is it expected a patient will reach stage four of sedation?

Answer 38

An hour

Question 39

What is phase 1 of intravenous sedation?

Answer 39

The drug is at its maximum potency. Co-ordination is impaired Positive eve's sign Unaware of surroundings

Question 40

What is phase 2 of intravenous sedation?

Answer 40

Alpha half life begins - drug potency decreases as it is redistributed throughout the body Awareness increases

Question 41

What is phase 3 of of intravenous sedation?

Answer 41

Anxiolytic effect is still active Patient starts to feel more like themselves Beta half life has not yet occured

Question 42

What is the usual dose of midazolam during IV sedation?

Answer 42

2.5mg - 7.5mg

Question 43

When two intravenous drugs are titrated together, it is known as what?

Answer 43

Polypharmacy

Question 44

What drug enhances the metabolism of midazolam?

Answer 44

St John's wort - resulting in a reduced effect

Question 45

How many vials of flumazenil should be available when sedation is taking place?

Answer 45

minimum of two

Question 46

1mg of flumazenil equates to how many ampoules?

Answer 46

2

Question 47

How is flumazenil excreted?

Answer 47

Urine

Question 48

Which intravenous drug does not have a reversal?

Answer 48

Propofol

Question 49

What schedule drug is Propofol?

Answer 49

Schedule IV

Question 50

Which drug can be administered intravenously, but also drank as a liquid?

Answer 50

Midazolam