Benzodiazepines - Midazolam Flashcards
Potency:
› Lorazepam > Midazolam > Diazepam
› Lorazepam ~ 5 times more potent than Midazolam.
› Midazolam ~ 5 times more potent that Diazepam.
Which of the following statements about the Imidazole ring in Midazolam is correct?
A. The Imidazole ring opens at a physiological pH, increasing lipid solubility.
B. The Imidazole ring closes at an acidic pH, decreasing water solubility.
C. The Imidazole ring opens at an acidic pH, increasing water solubility.
D. The Imidazole ring remains unaffected by pH changes.
C. The Imidazole ring opens at an acidic pH, increasing water solubility.
What is the primary effect of Midazolam’s Imidazole ring closing at physiological pH?
A. Increased water solubility
B. Increased lipid solubility
C. Decreased lipid solubility
D. Increased pH stability
B. Increased lipid solubility
For adult premedication, what is the recommended intravenous dose range for Midazolam?
A. 0.5-1 mg
B. 1-2 mg
C. 2-4 mg
D. 5-10 mg
B. 1-2 mg
When used for induction of anesthesia in adults, what is the typical dose range of Midazolam?
A. 0.05-0.1 mg/kg
B. 0.1-0.2 mg/kg
C. 0.2-0.3 mg/kg
D. 0.3-0.5 mg/kg
B. 0.1-0.2 mg/kg
What concentration of Midazolam is commonly available for intravenous administration?
A. 0.5 mg/mL
B. 1 mg/mL
C. 2 mg/mL
D. 5 mg/mL
B. 1 mg/mL
What is the primary mechanism of action of Midazolam?
A. NMDA receptor antagonist
B. GABAA receptor agonist
C. Dopamine receptor agonist
D. Serotonin receptor antagonist
B. GABAA receptor agonist
What effect does Midazolam have on the GABAA receptor?
A. Decreases the frequency of channel opening
B. Increases the frequency of channel opening
C. Blocks the channel completely
D. Inhibits receptor binding
B. Increases the frequency of channel opening
Which area of the brain does Midazolam primarily inhibit to induce sleep?
A. Cerebellum
B. Limbic system
C. Thalamic and mid-brain reticular activating system (RAS)
D. Basal ganglia
C. Thalamic and mid-brain reticular activating system (RAS)
What is the typical onset time for Midazolam when administered intravenously?
A. 30 seconds to 1 minute
B. 1-2 minutes
C. 2-5 minutes
D. 5-10 minutes
B. 1-2 minutes
What is the average duration of action for Midazolam, assuming normal hepatic clearance?
A. 30 minutes
B. 1 hour
C. 2 hours
D. 4 hours
B. 1 hour
Tx Wes Reference
1-5mg: 15-80 min
induction 0.1-0.2 mg/kg: 5-10 min
What is the half-life of Midazolam in a healthy adult?
A. 1-2 hours
B. 2-4 hours
C. 4-6 hours
D. 6-8 hours
B. 2-4 hours
How does the half-life of Midazolam change in elderly patients compared to younger adults?
A. It is shorter
B. It remains the same
C. It is doubled
D. It is tripled
C. It is doubled
What percentage of Midazolam is bound to plasma proteins?
A. 50%
B. 70%
C. 85%
D. 97%
D. 97%
Which enzyme systems are primarily responsible for the metabolism of Midazolam?
A. CYP450 in the liver and intestines
B. Glucuronidase in the liver
C. Esterases in the plasma
D. Monoamine oxidase in the liver
A. CYP450 in the liver and intestines
What is the active metabolite of Midazolam?
A. 1-hydroxymidazolam
B. 2-hydroxymidazolam
C. 3-hydroxymidazolam
D. Midazolam-2-sulfate
A. 1-hydroxymidazolam
What effect can the active metabolite 1-hydroxymidazolam have?
A. Decrease in sedation
B. Increase in delirium
C. Increase in pain
D. Decrease in amnesia
B. Increase in delirium
How is Midazolam primarily eliminated from the body?
A. Liver metabolism and fecal excretion
B. Kidneys
C. Lungs
D. Skin
B. Kidneys
In which clinical situations is Midazolam commonly used?
A. For chronic pain management
B. As a preoperative medication and induction agent
C. For long-term sedation in the ICU
D. For treatment of seizures
B. As a preoperative medication and induction agent
What is a notable characteristic of Midazolam’s formulation that prevents pain on injection?
A. Use of propylene glycol
B. Hydrophilic nature of the solution
C. Low concentration
D. High pH
B. Hydrophilic nature of the solution
no propylene glycol used = no pain d/t hydrophilic nature in solution
Propylene glycol is a synthetic liquid substance that absorbs water. It is used to absorb extra water and maintain moisture in certain medicines, cosmetics, or food products
What is the usual intravenous bolus dose of Midazolam given as patients are rolled back into the operating room?
A. 0.5 mg
B. 1 mg
C. 2 mg
D. 5 mg
C. 2 mg
Which of the following is NOT a primary effect of Midazolam?
A. Amnesic
B. Anxiolytic
C. Analgesic
D. Sedative
C. Analgesic
amnestic/anxiolytic > sedation
What cardiovascular effects are typically associated with Midazolam?
A. Significant increase in systemic vascular resistance (SVR)
B. Significant increase in heart rate (HR) and blood pressure (BP)
C. Minimal decrease in SVR, HR, and BP
D. Pronounced baroreceptor depression
C. Minimal decrease in SVR, HR, and BP
CV: How does Midazolam interact with induction drugs and opiates in terms of cardiovascular effects?
A. It has no interaction with these drugs
B. It can potentiate drops in blood pressure when used with induction drugs and opiates
C. It counteracts the effects of induction drugs and opiates
D. It increases heart rate and blood pressure when used with these drugs
B. It can potentiate drops in blood pressure when used with induction drugs and opiates
CV: What impact does Midazolam have on the sympathetic nervous system response to direct laryngoscopy (DL)?
A. It blunts the sympathetic nervous system response
B. It enhances the sympathetic nervous system response
C. It has no effect on the sympathetic nervous system response
D. It significantly depresses the sympathetic nervous system
C. It has no effect on the sympathetic nervous system response
minimal baroreceptor depression
Respiratory: What is the effect of Midazolam on respiratory function at sedative doses?
A. Significant respiratory stimulation
B. Minimal dose-dependent respiratory depression and apnea
C. Severe respiratory depression regardless of dose
D. Increased upper airway reflex activity
B. Minimal dose-dependent respiratory depression and apnea
Respiratory: How does Midazolam affect the swallow reflex and upper airway reflex activity?
A. It increases swallow reflex activity and upper airway reflexes
B. It has no effect on swallow reflex or upper airway reflexes
C. It depresses the swallow reflex and decreases upper airway reflex activity
D. It enhances upper airway reflexes while decreasing swallow reflex
C. It depresses the swallow reflex and decreases upper airway reflex activity
CNS: What is the effect of Midazolam at induction doses on cerebral metabolism and blood flow?
A. Increases cerebral metabolic rate for oxygen (CMRO2) and cerebral blood flow (CBF)
B. Decreases CMRO2 and CBF
C. Has no effect on CMRO2 and CBF
D. Decreases CMRO2 but increases CBF
B. Decreases CMRO2 and CBF
CNS: Which of the following effects is NOT produced by Midazolam?
A. Isoelectric EEG
B. Anterograde amnesia
C. Anticonvulsant activity
D. Skeletal muscle relaxation
A. Isoelectric EEG
cannot produce isoelectric EEG
CNS:What type of amnesia is associated with Midazolam use?
A. Retrograde amnesia
B. Anterograde amnesia
C. Dissociative amnesia
D. Transient global amnesia
B. Anterograde amnesia
Which of the following conditions can Midazolam be used to treat or manage?
A. Chronic pain syndrome
B. Alcohol withdrawal syndrome (etoh withdrawal)
C. Acute myocardial infarction
D. Insomnia
B. Alcohol withdrawal syndrome (etoh withdrawal)
CNS: In addition to its use as an anxiolytic, what other therapeutic use does Midazolam have?
A. Treatment of hypotension
B. Local anesthetic (LA) toxicity management
C. Antihypertensive therapy
D. Chronic obstructive pulmonary disease (COPD)
B. Local anesthetic (LA) toxicity management
What type of muscle relaxation effect does Midazolam provide, and in which condition is this particularly useful?
A. Peripheral muscle relaxation useful for post-surgical pain
B. Skeletal muscle relaxation mediated spinally, useful for conditions like cerebral palsy
C. Central muscle relaxation useful for fibromyalgia
D. Smooth muscle relaxation for gastrointestinal disorders
B. Skeletal muscle relaxation mediated spinally, useful for conditions like cerebral palsy
Which of the following statements about Midazolam’s ability to produce an isoelectric EEG is correct?
A. Midazolam can produce an isoelectric EEG similar to propofol and barbiturates.
B. Midazolam cannot produce an isoelectric EEG; this is only achieved with propofol and barbiturates.
C. Midazolam can produce an isoelectric EEG but only at high doses.
D. Midazolam’s effects on EEG are not well-documented.
Answer: B. Midazolam cannot produce an isoelectric EEG; this is only achieved with propofol and barbiturates.
What is the primary reason for the contraindication of Midazolam in patients older than 65 years?
A. Increased risk of severe respiratory depression
B. Increased risk of delirium and prolonged sedation
C. Enhanced cardiovascular effects
D. Reduced hepatic metabolism
B. Increased risk of delirium and prolonged sedation
Why is Midazolam contraindicated for long-term use in pregnant patients?
A. It has no placental crossing
B. It is associated with severe fetal toxicity
C. It crosses the placenta and can affect the fetus
D. It can cause prolonged labor
C. It crosses the placenta and can affect the fetus
Which of the following medications should be used with caution when administered with Midazolam due to its effects on CYP enzymes?
A. Lorazepam
B. Cimetidine, erythromycin, CCBs, antifungal, fentanyl, phenytoin
C. Acetaminophen
D. Metformin
B. Cimetidine, erythromycin, CCBs, antifungal, fentanyl, phenytoin
Drugs that cause inhibition of P-450 enzymes (decreased BZD metabolism):
-Cimetidine
-Erythromycin
-Calcium channel blockers
-Antifungal
-Fentanyl
