Reversal Agents - Flumazenil (Romazicon)

Question 1

What is the initial bolus dose of Flumazenil (Romazicon) when administered intravenously?

A) 0.1 mg
B) 0.2 mg
C) 0.3 mg
D) 0.5 mg

Answer 1

B) 0.2 mg

Dose Range:
0.2mg IV and titrated in 0.1mg increments q1 min to 3mg total.

0.3-0.6 mg to reverse sedation.

1.0.5-1.0mg to abolish therapeutic dose.

Question 2

How is the dose of Flumazenil (Romazicon) adjusted after the initial bolus if needed?

A) In 0.05 mg increments every 1 minute
B) In 0.1 mg increments every 5 minutes
C) In 0.1 mg increments every 1 minute
D) In 0.2 mg increments every 2 minutes

Answer 2

C) In 0.1 mg increments every 1 minute

Question 3

What is the concentration of Flumazenil (Romazicon) in a standard vial?

A) 0.5 mg/5 mL
B) 1 mg/5 mL
C) 1 mg/10 mL
D) 2 mg/10 mL

Answer 3

C) 1 mg/10 mL

Question 4

What is the mechanism of action (MOA) of Flumazenil (Romazicon)?

A) Non-competitive antagonist at GABAA receptors
B) Competitive antagonist at GABAA receptors
C) Agonist at benzodiazepine receptors
D) Inhibitor of GABA reuptake

Answer 4

B) Competitive antagonist at GABAA receptors

MOA: competitive GABAA receptor antagonist. Very high affinity but short duration of action.

Question 5

What is the duration of action for Flumazenil (Romazicon)?

A) 10-20 minutes
B) 20-30 minutes
C) 30-60 minutes
D) 60-90 minutes

Answer 5

C) 30-60 minutes

Duration: 30-60min (short duration so may need redosing)

Question 6

How is Flumazenil (Romazicon) metabolized in the body?

A) By renal filtration
B) By plasma esterases
C) By hepatic microsomal enzymes to inactive metabolites
D) By gastrointestinal absorption

Answer 6

C) By hepatic microsomal enzymes to inactive metabolites

Question 7

What is the approximate onset time for Flumazenil (Romazicon) to reverse benzodiazepine effects?

A) 30 seconds
B) 1 minute
C) 2 minutes
D) 5 minutes

Answer 7

C) 2 minutes

Question 8

Which of the following is a contraindication for the use of Flumazenil (Romazicon)?

A) Use in patients with liver disease
B) Co-administration with antiepileptic drugs
C) Reversal of non-benzodiazepine sedatives
D) Use in patients with hypertension

Answer 8

B) Co-administration with antiepileptic drugs

Question 9

Why should Flumazenil (Romazicon) be avoided in patients taking antiepileptic drugs?

A) It can cause prolonged sedation
B) It may precipitate acute withdrawal seizures
C) It interferes with drug metabolism
D) It can exacerbate anxiety

Answer 9

B) It may precipitate acute withdrawal seizures

Question 10

How does the side effect profile of Flumazenil (Romazicon) differ from Naloxone (Narcan) when used for post-operative reversal?

A) Flumazenil increases sympathetic nervous system (SNS) tone significantly
B) Flumazenil does not increase SNS tone, anxiety, or neuroendocrine evidence of stress.
C) Flumazenil causes profound anxiety and stress responses
D) Naloxone has no effect on SNS tone

Answer 10

B) Flumazenil does not increase SNS tone or neuroendocrine evidence of stress

S/E: Unlike post-op opioid reversal with naloxone (which causes a profound increase in SNS tone), post-op BZD reversal with flumazenil does not increase SNS tone, anxiety, or neuroendocrine evidence of stress.

Question 11

What is a potential risk associated with Flumazenil (Romazicon) in patients with chronic benzodiazepine (BZP) use?

A) Prolonged sedation
B) Increased SNS tone
C) Precipitation of withdrawal symptoms, including seizures
D) Enhanced amnestic effects

Answer 11

C) Precipitation of withdrawal symptoms, including seizures

In chronic bzd usage, reversal can precipitate signs of withdrawal, including seizures. Tends to reverse the sedative effects more than the amnestic effects of bzd.