Article: AENJ-D-15-00021
Date: April 23, 2015
Time: 3:57
EARN CE CREDIT ONLINE Go to http://www.nursingcenter.com/CE/AENJ and receive a certificate within minutes.
CE Test Benzodiazepine Selection in the Management of Status Epilepticus: A Review Test Instructions Read the article. The test for this CE activity can only be taken online at http://www.nursingcenter.com/CE/AENJ. Tests can no longer be mailed or faxed. You will need to create (its free!) and login to your personal CE Planner account before taking online tests. Your planner will keep track of all your Lippincott Williams & Wilkins online CE activities for you. There is only one correct answer for each question. A passing score for this test is 13 correct answers. If you pass, you can print your certificate of earned contact hours and access the answer key. If you fail, you have the option of taking the test again at no additional cost.
For questions, contact Lippincott Williams & Wilkins: 1-800-787-8985. r Registration deadline is June 30, 2017.
Provider Accreditation Lippincott Williams & Wilkins, the publisher of Advanced Emergency Nursing Journal, will award 2.5 contact hours including 1.5 Pharmacology credits for this continuing nursing education activity. Lippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This activity is also provider approved by the California Board of Registered Nursing, Provider Number
CEP 11749 for 2.5 contact hours. LWW is also an approved provider of continuing nursing education by the District of Columbia #50-1223 and Florida #50-1223. Your certificate is valid in all states. The ANCC’s accreditation status of Lippincott Williams & Wilkins Department of Continuing Education refers only to its continuing nursing educational activities and does not imply Commission on Accreditation approval or endorsement of any commercial product.
Disclosure Statement The authors and planners have disclosed that they have no financial relationships related to this article.
CE TEST QUESTIONS General Purpose: To provide information on the use of benzodiazepines in the management of status epilepticus (SE). Learning Objectives: After completing this continuing education activity, you should be able to: 1. Compare and contrast routes, formulations, and pharmacokinetics of benzodiazepines used in the treatment of SE. 2. Examine treatment guidelines and research results for the use of benzodiazepines to manage SE. 1. Which benzodiazepine is available in quick-dissolving wafers? a. diazepam b. midazolam c. clonazepam 2. Which administration route leads to more rapid systemic levels of benzodiazepines? a. oral b. rectal c. intramuscular 3. Which drug has the slowest distribution from muscle tissue? a. lorazepam b. diazepam c. midazolam 4. According to the 2012 Neurocritical Care Society (NCCS), the drug of choice for intravenous treatment of SE is a. lorazepam. b. diazepam. c. midazolam. 5. If intravenous access is unavailable, the NCCS drug of choice for intramuscular administration is a. clonazepam. b. midazolam. c. lorazepam.
6. The NCCS’ recommended dosing of intravenous lorazepam to treat SE is a. 0.1 mg/kg. b. 0.15 mg/kg. c. 0.2 mg/kg. 7. According to the NCCS guidelines, intranasal midazolam may be repeated every a. 2 min. b. 5 min. c. 10 min. 8. After administration, midazolam drops in concentration in the cerebrospinal fluid in approximately a. 10 min. b. 20 min. c. 30 min. 9. Which parenteral agent is preferred in patients with reduced liver function? a. lorazepam b. diazepam c. midazolam 10. The agent that does not require the use of propylene glycol in its formulation is a. lorazepam. b. diazepam. c. midazolam. 11. Which statement is true regarding lorazepam? a. It has lower viscosity than midazolam. b. It has poor chemical stability at room temperature. c. It works well in an atomizer device. 12. Results of the study by Treiman et al. (1998) revealed a. phenobarbital alone resulted in the highest rate of seizure recurrence. b. diazepam plus phenytoin resulted in the highest rate of side effects. c. lorazepam was the most effective and took the least amount of time to infuse.
E2
13. Regarding the prehospital use of benzodiazepines for SE, Alldredge et al. (2001) concluded that a. less respiratory depression occurred in patients treated with benzodiazepines than with placebo. b. diazepam was favored over lorazepam for seizure cessation. c. lorazepam resulted in a higher rate of seizure recurrence than diazepam. 14. In the Rapid Anticonvulsant Medication Prior to Arrival Trial, midazolam or a placebo was administered via a/an a. autoinjector. b. atomizer. c. rectal suppository. 15. Compared with the placebo group in the study by Cereghino et al. (2002), patients who received rectal diazepam had a a. shorter duration until the next seizure. b. higher incidence of remaining seizure free. c. higher incidence of clinically serious adverse events. 16. Wolfe and Macfarland (2005) concluded that intranasal midazolam is a. as effective as intravenous lorazepam. b. more effective than rectal diazepam. c. at least as effective as intravenous phenytoin. 17. What drug earned a Class IIb recommendation for the urgent treatment phase of SE? a. valproate sodium b. clonazepam c. pentobarbital 18. In cases of SE refractory to initial treatment, the NCCS recommends using a. phenytoin. b. propofol. c. levetiracetam.
Date: April 23, 2015
Time: 3:57
EARN CE CREDIT ONLINE Go to http://www.nursingcenter.com/CE/AENJ and receive a certificate within minutes.
CE Test Benzodiazepine Selection in the Management of Status Epilepticus: A Review Test Instructions Read the article. The test for this CE activity can only be taken online at http://www.nursingcenter.com/CE/AENJ. Tests can no longer be mailed or faxed. You will need to create (its free!) and login to your personal CE Planner account before taking online tests. Your planner will keep track of all your Lippincott Williams & Wilkins online CE activities for you. There is only one correct answer for each question. A passing score for this test is 13 correct answers. If you pass, you can print your certificate of earned contact hours and access the answer key. If you fail, you have the option of taking the test again at no additional cost.
For questions, contact Lippincott Williams & Wilkins: 1-800-787-8985. r Registration deadline is June 30, 2017.
Provider Accreditation Lippincott Williams & Wilkins, the publisher of Advanced Emergency Nursing Journal, will award 2.5 contact hours including 1.5 Pharmacology credits for this continuing nursing education activity. Lippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This activity is also provider approved by the California Board of Registered Nursing, Provider Number
CEP 11749 for 2.5 contact hours. LWW is also an approved provider of continuing nursing education by the District of Columbia #50-1223 and Florida #50-1223. Your certificate is valid in all states. The ANCC’s accreditation status of Lippincott Williams & Wilkins Department of Continuing Education refers only to its continuing nursing educational activities and does not imply Commission on Accreditation approval or endorsement of any commercial product.
Disclosure Statement The authors and planners have disclosed that they have no financial relationships related to this article.
CE TEST QUESTIONS General Purpose: To provide information on the use of benzodiazepines in the management of status epilepticus (SE). Learning Objectives: After completing this continuing education activity, you should be able to: 1. Compare and contrast routes, formulations, and pharmacokinetics of benzodiazepines used in the treatment of SE. 2. Examine treatment guidelines and research results for the use of benzodiazepines to manage SE. 1. Which benzodiazepine is available in quick-dissolving wafers? a. diazepam b. midazolam c. clonazepam 2. Which administration route leads to more rapid systemic levels of benzodiazepines? a. oral b. rectal c. intramuscular 3. Which drug has the slowest distribution from muscle tissue? a. lorazepam b. diazepam c. midazolam 4. According to the 2012 Neurocritical Care Society (NCCS), the drug of choice for intravenous treatment of SE is a. lorazepam. b. diazepam. c. midazolam. 5. If intravenous access is unavailable, the NCCS drug of choice for intramuscular administration is a. clonazepam. b. midazolam. c. lorazepam.
6. The NCCS’ recommended dosing of intravenous lorazepam to treat SE is a. 0.1 mg/kg. b. 0.15 mg/kg. c. 0.2 mg/kg. 7. According to the NCCS guidelines, intranasal midazolam may be repeated every a. 2 min. b. 5 min. c. 10 min. 8. After administration, midazolam drops in concentration in the cerebrospinal fluid in approximately a. 10 min. b. 20 min. c. 30 min. 9. Which parenteral agent is preferred in patients with reduced liver function? a. lorazepam b. diazepam c. midazolam 10. The agent that does not require the use of propylene glycol in its formulation is a. lorazepam. b. diazepam. c. midazolam. 11. Which statement is true regarding lorazepam? a. It has lower viscosity than midazolam. b. It has poor chemical stability at room temperature. c. It works well in an atomizer device. 12. Results of the study by Treiman et al. (1998) revealed a. phenobarbital alone resulted in the highest rate of seizure recurrence. b. diazepam plus phenytoin resulted in the highest rate of side effects. c. lorazepam was the most effective and took the least amount of time to infuse.
E2
13. Regarding the prehospital use of benzodiazepines for SE, Alldredge et al. (2001) concluded that a. less respiratory depression occurred in patients treated with benzodiazepines than with placebo. b. diazepam was favored over lorazepam for seizure cessation. c. lorazepam resulted in a higher rate of seizure recurrence than diazepam. 14. In the Rapid Anticonvulsant Medication Prior to Arrival Trial, midazolam or a placebo was administered via a/an a. autoinjector. b. atomizer. c. rectal suppository. 15. Compared with the placebo group in the study by Cereghino et al. (2002), patients who received rectal diazepam had a a. shorter duration until the next seizure. b. higher incidence of remaining seizure free. c. higher incidence of clinically serious adverse events. 16. Wolfe and Macfarland (2005) concluded that intranasal midazolam is a. as effective as intravenous lorazepam. b. more effective than rectal diazepam. c. at least as effective as intravenous phenytoin. 17. What drug earned a Class IIb recommendation for the urgent treatment phase of SE? a. valproate sodium b. clonazepam c. pentobarbital 18. In cases of SE refractory to initial treatment, the NCCS recommends using a. phenytoin. b. propofol. c. levetiracetam.
