CSC Pharmacology of Sedative Agents 3 — Questions and Answers
Question 1: A 70 kg patient is receiving IV midazolam. The provider notes paradoxical agitation. What is the BEST next step?
- Increase the midazolam dose
- Administer flumazenil and reassess (Correct answer)
- Add ketamine for deeper sedation
- Administer diphenhydramine
Correct answer: Administer flumazenil and reassess
Paradoxical excitation with benzodiazepines is an indication to reverse the drug with flumazenil rather than escalating the dose.
Question 2: Which opioid used in conscious sedation has the fastest onset and shortest duration of action?
- Morphine
- Hydromorphone
- Fentanyl (Correct answer)
- Meperidine
Correct answer: Fentanyl
Fentanyl has an onset of 1–2 minutes IV and a clinical duration of 30–60 minutes, making it the preferred opioid for short procedural sedation.
Question 3: Propofol should be used with caution or avoided in patients with allergy to which substance?
- Shellfish
- Soy protein or egg lecithin (Correct answer)
- Latex
- Penicillin
Correct answer: Soy protein or egg lecithin
Propofol is formulated in a lipid emulsion containing soy bean oil and egg lecithin; patients with confirmed allergies to these components may be at risk.
Question 4: Which characteristic of ketamine makes it particularly useful in hemodynamically unstable patients?
- It causes vasodilation
- It stimulates catecholamine release, maintaining blood pressure (Correct answer)
- It has no effect on cardiac output
- It reduces myocardial oxygen demand
Correct answer: It stimulates catecholamine release, maintaining blood pressure
Ketamine stimulates sympathetic nervous system activity and catecholamine release, generally supporting blood pressure and heart rate.
Question 5: The onset of action for IV midazolam is approximately:
- 30–60 seconds
- 2–3 minutes (Correct answer)
- 10–15 minutes
- 20–30 minutes
Correct answer: 2–3 minutes
IV midazolam typically achieves peak sedative effect within 2–3 minutes, allowing for careful titration during procedures.
Question 6: Which sedative agent is contraindicated in patients with acute porphyria?
- Midazolam
- Propofol
- Ketamine
- Barbiturates such as thiopental (Correct answer)
Correct answer: Barbiturates such as thiopental
Barbiturates induce hepatic aminolevulinic acid synthase, precipitating acute porphyric crises; they are absolutely contraindicated in porphyria.
Question 7: A patient receiving ketamine for procedural sedation develops laryngospasm. What is the MOST likely contributing factor?
- Ketamine-induced hypotension
- Airway secretions not managed prior to procedure (Correct answer)
- Paradoxical NMDA receptor activation
- Opioid co-administration
Correct answer: Airway secretions not managed prior to procedure
Ketamine increases oral secretions; if not managed with an antisialagogue (e.g., glycopyrrolate), excess secretions can trigger laryngospasm.
CSC Pharmacology of Sedative Agents 3
A 70 kg patient is receiving IV midazolam.
The provider notes paradoxical agitation.
What is the BEST next step?