CNS drugs and antiepileptics: rescue midazolam without IV access: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · CNS drugs and antiepileptics: rescue midazolam without IV access

Sample item

A 7-year-old with known epilepsy has been convulsing for six minutes at home. There is no intravenous access and the nearest hospital is 30 minutes away. Which rescue treatment is most appropriate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Intranasal midazolam

A seizure lasting more than five minutes is treated as status epilepticus. When there is no intravenous access, buccal or intranasal midazolam works fast through mucosal absorption and can be given by carers. Rectal or intramuscular alternatives also exist, but oral antiepileptics are too slow in a convulsing child.

Option by option

  • A. Intranasal midazolam (correct)

    Correct. Intranasal (or buccal) midazolam acts within minutes through mucosal absorption and needs no IV access.

  • B. Rectal paracetamol

    Paracetamol treats fever and has no anticonvulsant action.

  • C. Oral carbamazepine syrup

    Oral carbamazepine is for maintenance and cannot be given to a convulsing child.

  • D. Oral phenytoin suspension

    Oral phenytoin is slowly absorbed and cannot be swallowed safely during a convulsion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pharmacology questions

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, Intranasal midazolam. A seizure lasting more than five minutes is treated as status epilepticus.

Why is "Rectal paracetamol" not the answer?

Paracetamol treats fever and has no anticonvulsant action.

Why is "Oral carbamazepine syrup" not the answer?

Oral carbamazepine is for maintenance and cannot be given to a convulsing child.

Why is "Oral phenytoin suspension" not the answer?

Oral phenytoin is slowly absorbed and cannot be swallowed safely during a convulsion.

What concept does this question test?

It tests CNS drugs and antiepileptics: rescue midazolam without IV access in Pharmacology. When there is no intravenous access, buccal or intranasal midazolam works fast through mucosal absorption and can be given by carers. Rectal or intramuscular alternatives also exist, but oral antiepileptics are too slow in a convulsing child.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study CNS drugs and antiepileptics: rescue midazolam without IV access?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.