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KM (Spring 2024) Anesthesia Pharm ** > PreOp Meds: Midazolam > Flashcards

PreOp Meds: Midazolam Flashcards

1
Q

Which structural feature of midazolam contributes to its stability and allows for rapid metabolism?

A. Benzene ring
B. Imidazole ring
C. Phenol group
D. Ester bond

A

B. Imidazole ring

Acidic pH→ opens ring ↑ water solubility.
Physiologic pH→ closes ring ↑ lipid solubility

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2
Q

Midazolam is primarily used in which two clinical situations?

A. Pain management and general anesthesia
B. Preoperative anxiolysis and conscious sedation
C. Muscle relaxation and seizure control
D. Postoperative nausea and vomiting prevention

A

B. Preoperative anxiolysis and conscious sedation

amnestic/anxiolytic > sedation

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3
Q

How much more potent is midazolam compared to diazepam, and what is the reason for this difference?

A. 2-3 times more potent due to greater receptor affinity
B. 2-3 times less potent due to faster metabolism
C. Equally potent due to similar chemical structures
D. 5 times more potent due to increased lipid solubility

A

A. 2-3 times more potent due to greater receptor affinity

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4
Q

Here

Why is midazolam non-irritating upon injection?

A. It contains a local anesthetic agent.
B. It does not require propylene glycol for stabilization.
C. It is diluted in a saline solution.
D. It is formulated as a slow-release injection.

A

B. It does not require propylene glycol for stabilization.

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5
Q

1.What is the typical onset time for midazolam?

A. 5-10 seconds
B. 1-2 minutes
C. 10-15 minutes
D. 30-60 seconds

2.How long does it typically take for midazolam to reach its peak effect?

A. 1 minute
B. 3 minutes
C. 5 minutes
D. 10 minutes

A
  1. B. 1-2 minutes Onset
  2. C. 5 minutes Peak

TXWes reference guide says 1-5 mins

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6
Q

What is the typical duration of action for midazolam?

A. 5-15 minutes
B. 15-80 minutes
C. 1-2 hours
D. 2-4 hours

A

B. 15-80 minutes

Short due to rapid redistribution

According to TXWes reference guide

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7
Q

What is the Elimination half-time of midazolam, and how does it change in elderly patients?

A. 1 hour; doubles to 2 hours in elderly patients
B. 2 hours; doubles to 4 hours in elderly patients
C. 4 hours; increases to 6 hours in elderly patients
D. 3 hours; remains unchanged in elderly patients

A

B. 2 hours; doubles to 4 hours in elderly patients

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8
Q

What is the volume of distribution (Vd) of midazolam?

A. 0.5-1.0 L/kg
B. 1.0-1.5 L/kg
C. 1.5-2.0 L/kg
D. 2.0-2.5 L/kg

A

B. 1.0-1.5 L/kg

(large due to lipid-solubility)

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9
Q

Which organs and enzyme system are primarily responsible for the metabolism of midazolam?

A. Liver (CYP450) and Kidneys (CYP450)
B. Liver (CYP450) and Intestines (CYP450)
C. Kidneys (CYP450) and Lungs (CYP450)
D. Lungs (CYP450) and Intestines (CYP450)

What is the primary metabolite and it’s significance?

A

B. Liver (CYP450) and Intestines (CYP450)

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10
Q

What is the active metabolite of midazolam?

A. 1-hydroxypropofol
B. 1-hydroxydiazepam
C. 1-hydroxymidazolam
D. 1-hydroxyketamine

A

C. 1-hydroxymidazolam

*½ the activity of midazolam
*causing increase in delirium

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11
Q

What organ is responsible for clearing the active metabolite of midazolam (1-hydroxymidazolam)?

A. Liver
B. Lungs
C. Kidneys
D. Intestines

A

C. Kidneys

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12
Q

Which of the following drugs are known to inhibit CYP450 enzymes? Select all that apply.

A. Cimetidine
B. Erythromycin
C. Calcium Channel Blockers (CCBs)
D. Antifungals
E. Fentanyl
F. Phenytoin

A

A. Cimetidine
B. Erythromycin
C. Calcium Channel Blockers (CCBs)
D. Antifungals
E. Fentanyl
F. Phenytoin

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13
Q

How does midazolam’s clearance compare to Lorazepam and Diazepam?

A. 2 times faster than Lorazepam and 4 times faster than Diazepam
B. 3 times faster than Lorazepam and 6 times faster than Diazepam
C. 5 times faster than Lorazepam and 10 times faster than Diazepam
D. 1.5 times faster than Lorazepam and 2 times faster than Diazepam

A

C. 5 times faster than Lorazepam and 10 times faster than Diazepam

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14
Q

True or False

Midazolam produces an isoelectric EEG.

A

False.

No isoelectric EEG capabilities.

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15
Q

Midazolam (inhibits/preserves) the vasomotor response to CO₂. What does this mean?

A

Preserves the vasomotor response to CO₂

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16
Q

Why is midazolam considered a good choice for neuroanesthesia?

A. It reduces cerebral blood flow.
B. It decreases intracranial pressure (ICP).
C. It increases cerebral perfusion pressure.
D. It does not cause changes in intracranial pressure (ICP).

A

D. It does not cause changes in intracranial pressure (ICP).

Induction dose: ↓ CMRO2 and CBF

17
Q

Which of the following are central nervous system (CNS) effects of midazolam? Select all that apply.

A. Anterograde amnesia
B. Anticonvulsant effect
C. Use in ethanol withdrawal and local anesthetic (LA) toxicity
D. Retrograde amnesia
E. Spinally mediated skeletal muscle relaxation
F. Increase in intracranial pressure (ICP)

A

A. Anterograde amnesia
B. Anticonvulsant effect
C. Use in ethanol withdrawal and local anesthetic (LA) toxicity
E. Spinally mediated skeletal muscle relaxation

18
Q

Which of the following are pulmonary effects of midazolam? Select all that apply.

A. Dose-dependent respiratory depression (increased with COPD) and apnea
B. Swallow reflex depression (risk of aspiration)
C. Upper airway depression (risk of aspiration)
D. Bronchospasm
E. Hyperventilation

A

A. Dose-dependent respiratory depression (increased with COPD) and apnea

B. Swallow reflex depression (risk of aspiration)

C. Upper airway depression (risk of aspiration)

19
Q

Which of the following cardiovascular effects are associated with midazolam?

A. Significant increase in systemic vascular resistance (SVR) and heart rate (HR)
B. Minimal decrease in systemic vascular resistance (SVR), heart rate (HR), and blood pressure (BP)
C. Severe hypotension and bradycardia
D. Increase in cardiac output and blood pressure

A

B. Minimal decrease in systemic vascular resistance (SVR), heart rate (HR), and blood pressure (BP)

Can potentiate drops with induction drugs and opiates

20
Q

True or False

Midazolam depresses cardiac output.

A

False.

No CO depression;
Minimal baroreceptor depression

Does not blunt SNS from DL.

21
Q

In which clinical scenario is midazolam more likely to cause significant hypotension?

A. In a patient with normovolemia
B. In a patient with hypovolemia
C. In a patient with hypertension
D. In a patient with bradycardia

A

B. In a patient with hypovolemia

22
Q

Dose Range

What is the typical premedication dose of midazolam?

A. 0.5-1 mg IV
B. 1-2 mg IV
C. 2-4 mg IV
D. 4-6 mg IV

A

B. 1-2 mg IV

23
Q

Dose Range

What is the typical induction dose of midazolam for anesthesia in adults?

A. 0.05-0.1 mg/kg
B. 0.1-0.2 mg/kg
C. 0.2-0.4 mg/kg
D. 0.4-0.6 mg/kg

A

B. 0.1-0.2 mg/kg

over 30-60seconds

24
Q

After administering Midazolam, which drug is typically given next?

A. Anticholinergic
B. Antihypertensive
C. Opiate
D. Muscle relaxant

A

C. Opiate

Fentanyl 50-100mcg

25
Q

Pediatric

What is the typical preoperative or intraoperative sedation dose of midazolam for pediatric patients?

A. 0.1-0.2 mg/kg PO
B. 0.25-0.5 mg/kg PO
C. 0.5-1.0 mg/kg PO
D. 1.0-1.5 mg/kg PO

A

B. 0.25-0.5 mg/kg PO

26
Q

Pediatric

When do the effects of midazolam peak in pediatric patients, and what is the clinical consequence of this?

A. Peaks in 5-10 minutes; administer just before entering the OR
B. Peaks in 20-30 minutes; administer 30 minutes prior to OR
C. Peaks in 1 hour; administer 1 hour before surgery
D. Peaks in 45 minutes; administer 45 minutes before surgery

A

B. Peaks in 20-30 minutes; administer 30 minutes prior to OR

27
Q

Dose Range

What is the typical postoperative sedation dose of midazolam?

A. 0.5-2 mg/hr IV
B. 1-7 mg/hr IV
C. 5-10 mg/hr IV
D. 10-15 mg/hr IV

A

B. 1-7 mg/hr IV

28
Q

For how long should midazolam be used for long-term sedation, and why?

A. 1 week; to prevent tolerance
B. 2-3 days; due to unclear effects on T-cell response
C. 4-5 days; to maintain consistent sedation
D. 6-7 days; to avoid withdrawal symptoms

A

B. 2-3 days;
due to unclear effects on T-cell response

29
Q

In which of the following patients is use of midazolam contraindicated? Select all that apply.

A. Pregnant patients long-term use due to placental crossing
B. Patients older than 65 years old
C. Pediatric patients
D. Patients with chronic pain conditions

A

A. Pregnant patients long-term use due to placental crossing
B. Patients older than 65 years old

KM (Spring 2024) Anesthesia Pharm ** (101 decks)

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