meds; benzos

Question 1

Diazepam dose IV and PO

Answer 1

Valium; IV 0.1 mg/kg
PO; 0.2 mg/kg

Question 2

Lorazepam dose

Answer 2

Ativan; 0.04 mg/kg

Question 3

Diazepam onset

Answer 3

1-5 min

Question 4

Diazepam duration

Answer 4

2-6 hr

Question 5

Lorazepam onset

Answer 5

1-5 min

Question 6

lorazepam duration

Answer 6

6-10 hr

Question 7

Midazolam dose bolus and gtt

Answer 7

Versed; 1-5 mg (0.05mg/kg)

gtt; 1-7 mg/hr

Question 8

Midazolam onset

Answer 8

1-5 min

Question 9

Midazolam induction dose

Answer 9

0.1-0.2 mg/kg

Question 10

Midazolam duration

Answer 10

15-80 min

Question 11

midazolam maintenance dose

Answer 11

precede induction dose with fentanyl 50-100 mcg

Question 12

Flumazenil dose, repeat and MAX

Answer 12

0.2 mg (repeat 0.1 q 1 min to a total of 1mg in the first hour and MAX 3 mg)

Question 13

Midazolam peak

Answer 13

5 min

Question 14

flumazenil concetration

Answer 14

0.1 mg/ml vials.

Question 15

Flumazenil onset

Answer 15

1-5 min

Question 16

Flumazenil duration

Answer 16

30 min

Question 17

other name for flumazenil

Answer 17

Romazicon

Question 18

MOA of midazolam

Answer 18

increase gaba affinity to GABA A receptor -> increase Cl- opening -> hyperpolarized post synaptic membrane = inhibition of depolarization

spinal cord mediated skm relaxation but not paralysis

Question 19

Midazolam metabolism

Answer 19

Cyp3A4
acitve metabolites 1/2 as active (1-hydroxymidazolam)

Question 20

Midazolam side effects

Answer 20

inhibits plat aggregation?
decreased T - cell and immune response (gtts mostly)
teratogenic

Question 21

Midazolam in the elderly

Answer 21

half life doubles due to decreased hepatic flow

Question 22

pulmonary effects of midazolam

Answer 22

decreased hypoxic drive and decreased swallow and cough reflex
> depression with COPD

Question 23

Diazepam metabolism

Answer 23

CPY 3A
active metabolites (48-96 hrs)
as potent as parent

Question 24

Diazepam Side effects

Answer 24

-return to drowsiness in 6-8 hrs
-can produce isoelectric EEG
-Pain on injection

Question 25

Lorazepam metabolism

Answer 25

Conjugation to inactive metabolites

Question 26

diazepam MOA

Answer 26

binds to gaba /alpha/ gamma subunits
Gaba -> cl channels opening hyperpolarize cell membrane -> no ap transmitted

alpha 1; sedation, amnetic, anticonvulsant
found in cerebral cortex and thalamus

alpha 2; anxiolytic, skm
found in hypocampus and amygdala

Question 27

Flumazenil MOA

Answer 27

Competitive antagonist -> increase affinity to benzodiazepine receptor

Question 28

Side effects of flumazenil

Answer 28

anxiety, htn, tachycardia, changes MAC of volatiles

Question 29

Who do we not give flumazenil to?

Answer 29

Sz pts

Question 30

Benzos are usually weak acids or bases?

Answer 30

Acids

Question 31

Benzo potency

Answer 31

Lorazepam > Midazolam > Diazepam.
Lorazepam ~ 5 times more potent than Midazolam.
Midazolam ~ 5 times more potent that Diazepam