Benzo/Barbiturate/Flumazanil

Question 1

Benzo receptor

Answer 1

Ionotropic GABAa receptor

Question 2

Benzo MOA

Answer 2

increase frequency of CL channel -> cell hyperpolarization -> depression of reticular activating system (RAS)

Question 3

Benzo indication

Answer 3

anxiolytics, amnesia, emergence delirium, skeletal muscle relaxation (high dose)

Question 4

Benzo Contraindication

Answer 4

Judicious use with other cardiorespiratory depressants

Question 5

Benzo absorption

Answer 5

5-60 min for PO

Question 6

Benzo Distribution

Answer 6

rapid penetration of CNS (7 min for IV midazolam)

Question 7

Benzo Biotransformation

Answer 7

Hepatic CYP450, phase 2 glucuronidation

Question 8

Benzo Elimination

Answer 8

Renal half-time: 2.5 hr (midazolam)

Question 9

Benzo Neuro Effect

Answer 9

Down CMRO2, CBF, ICP
anticonvulsant
anxiolytics,sedation
antegrade and retrograde amnesia
disinhibition, dysphoria 
Risk post cognitive dysfunction

Question 10

Dysphoria is most commonly seen in what population?

Answer 10

PTSD (military, sexual assault)

Question 11

Benzo resp/cardiac effects

Answer 11

decrease RR,Vt, MV, protective reflexes, hypoxic and hypercarbic ventilatory response
minimal card effect

Question 12

Midazolam dose

Answer 12

premed: 2-4 mg IV
elderly: 0.5-2 mg IV
ped: 0.5 mg/kg PO (max 40 mg)
seizure termination: 2-5 mg IV (max 10 mg)

Question 13

Midazolam onset

Answer 13

IV: 2-3 min
PO: 15-20 min

Question 14

Midazolam peak

Answer 14

7-10 min

Question 15

Midazolam Duration

Answer 15

30-60 min

Question 16

Flumazenil MOA

Answer 16

lower frequency of Cl channel opening -> cell repolarization

Question 17

Flumazenil distribution

Answer 17

peak 5 min

Question 18

Flumazenil biotransformation

Answer 18

hepatic phase 2

Question 19

Flumazenil elimination

Answer 19

renal half time 0.5-1 hr

Question 20

Flumazenil neuro effects

Answer 20

increase CMRO2, CBF, ICP, proconvulsant properties, agitation, confusion, delirium, hallucinations

Question 21

Flumazenil resp/card effects

Answer 21

increase RR, Vt, MV, protective reflexes, hypo and hypercarbic ventilatory responses
htn and dysrhythmia with rapid admin

Question 22

Flumazenil dose

Answer 22

0.2 - 0.5 mg IV for benzo reversal, max dose 1 mg

Question 23

benzo contraindication

Answer 23

pregnant woman