Q: For seizure, If IV access is not available, midazolam can be given all of the following routes except

A) Intra-Muscular (IM)
B) Nasally
C) Buccally
D) Rectally


Answer:  D
If IV access is not available, midazolam is a preferred benzodiazepine. which can be given in a dose of 10 mg as IM, nasally or buccally. Theoretically nasal and buccal routes may be more quicker in action. 

Valproate is the only anti-seizure drug which can be given rectally.


References:

1. Arya R, Kothari H, Zhang Z, et al. Efficacy of nonvenous medications for acute convulsive seizures: A network meta-analysis. Neurology 2015; 85:1859. 

2. Hirsch LJ. Intramuscular versus intravenous benzodiazepines for prehospital treatment of status epilepticus. N Engl J Med 2012; 366:659.