IV sedation M9

Question 1

What family of drugs does Midazolam belong to?

Answer 1

Benzodiazepines

Question 2

What does Anxiolytic mean?

Answer 2

Reduces anxiety

Question 3

What does Hypnotic mean?

Answer 3

Induces sleep

Question 4

What does Anticonvulsant mean?

Answer 4

Reduces the risk of convulsive fit

Question 5

What does Anterograde amnesia mean?

Answer 5

The patient may not remember treatment after the drug has been administered

Question 6

What three concentrations can Midazolam be obtained in?

Answer 6

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

Question 7

What is the most common concentration of Midazolam in a dental surgery?

Answer 7

5mg in 5ml, reduces risk of over sedation

Question 8

Midazolam binds to which receptors in the CNS?

Answer 8

Benzodiazepine receptors

Question 9

Benzodiazepine receptors run parallel to which other receptors?

Answer 9

Gamma-aminobutyric acid (GABA)

Question 10

Benzodiazepine enhances the effect of neurotransmitters on the GABA receptors leading the brain to do what?

Answer 10

Decreased brain activity

Question 11

What is half-life?

Answer 11

The time it takes for plasma levels of the drug to drop in half

Question 12

Name the two stages that form the Benzodiazepines half-life?

Answer 12

Alpha & Beta

Question 13

What does the Alpha half-life do?

Answer 13

Distribution and redistribution - travels to the brain and then from the brain to other tissues in the body.

Question 14

How long is the Alpha half-life?

Answer 14

4-18 minutes

Question 15

What does the Beta half-life do?

Answer 15

Metabolism & Excretion (the body breaks down so it is no longer active, then removed from the body)

Question 16

How long is the Beta half-life?

Answer 16

1-4 hours (can be longer for elderly/teens)

Question 17

What is the standard dose of Midazolam with an ASA I?

Answer 17

Initial: 2mg over 30secs - monitored for 2 mins
Further: 0.5-1mg

Question 18

What is the usual total dose for ASA I of Midazolam?

Answer 18

2.5mg-7.5mg

Question 19

What is the standard dose of Midazolam for an elderly patient?

Answer 19

Initial: 1mg - 1.5mg over 2 mins
should not exceed 3.5mg

Question 20

Why is midazolam not recommended for pregnant women?

Answer 20

Because the drug passes through the placental barrier and enters the fetal bloodB

Question 21

Why is midazolam not recommended for children?

Answer 21

Due to the paradoxical effect (agitation, involuntary movements & hyperactivity)

Question 22

Why would someone with a kidney or liver impairment possibly have issues during/after sedation?

Answer 22

May lead to a slower excretion rate, effects may be enhanced or prolonged

Question 23

If a patient has an adverse reaction to Midazolam, due to a known benzodiazepine allergy, what would you do?

Answer 23

Administration stopped
Airway maintained
Oxygen provided
Adrenaline administered

Question 24

What opiate is occasionally used in conjunction with midazolam to enhance the sedation effects?

Answer 24

Nubain / Nalbuphie

Question 25

What is Nubians reversal drug?

Answer 25

Narcan

Question 26

This drug inhibits the metabolism of Midazolam resulting in a prolonged effect?

Answer 26

Erythromycin

Question 27

This supplement enhances the effect of Midazolam reducing the effect?

Answer 27

St Johns Wart

Question 28

What drug is used for the treatment of over sedation?

Answer 28

Flumazenil

Question 29

What is the maximum does of Flumazenil?

Answer 29

1mg

Question 30

Flumazenil is obtained in which concentration?

Answer 30

500mcg in 5ml

Question 31

How is Flumazenil titrated?

Answer 31

200 mcg over 15 seconds further 100 mcg every minute

Question 32

What is the normal dose of Flumazenil?

Answer 32

300 mcg - 600 mcg

Question 33

What is the half life of Flumazenil?

Answer 33

50 minutes

Question 34

Name two contraindications of Flumazenil?

Answer 34

Coronary heart disease Epileptic patients on medication

Question 35

What is Propofol?

Answer 35

Amnesic and hypnotic drug used to maintain general anaesthetic

Question 36

How does Propofol work?

Answer 36

By strengthening the effect of the GABA to depress the CNS - does not use receptors directly

Question 37

What concentration is Propofol obtained in?

Answer 37

200mg in 20 ml (white liquid)

Question 38

What is the half-life of Propofol?

Answer 38

2-24 minutes with 5 min recovery time

Question 39

How is Propofol given to the patient?

Answer 39

Electronic fusion pump, at intervals. Too painful to push through smaller veins

Question 40

Name the three contraindications of Propofol?

Answer 40

Patients taking respiratory depressants Pregnancy/Nursing Egg allergy

Question 41

What is Eve sign positive?

Answer 41

The patient is unable to touch their nose

Question 42

What is Eve sign negative?

Answer 42

The patient is able to touch their nose

Question 43

How quickly does the patient reach stage IV, after the drug has been administered?

Answer 43

approx. 1 hour

Question 44

What is the phase of sedation when the drug within the brain is at its highest? What are the effects?

Answer 44

Phase I Behaviour changes Slurred speech Unaware of surroundings

Question 45

What is the phase of sedation when the drug in the body starts to decrease, which is caused by the redistribution of the drug within the body?

Answer 45

Phase II Patient becomes more aware Amnesic effect decreases

Question 46

What is the phase of sedation is it when the patient will appear relaxed and begin to feel normal?

Answer 46

Phase III Patient will not be anxious Anxiolytic effect still present

Question 47

What is the phase of sedation when the patient will appear recovered? But only the Alpha half-life has occurred.

Answer 47

Phase IV Amnesic effect has been know to last until this phase.