Midazolam

Question 1

Presentation

Answer 1

5 mg in 1 ml glass ampoule

15 mg in 3 ml glass ampoule

Question 2

Pharmacology

Answer 2

Short acting CNS depressant

Actions:

• Anxiolytic
• Sedative
• Anti-convulsant

Question 3

Metabolism

Answer 3

• in the liver

- excreted by the kidneys

Question 4

Indications

Answer 4

• status epilepticus
• sedation to enable intubation (RSI / IFS)
• post intubation sedation
• sedation to facilitate synchronised cardioversion
• sedation to facilitate transthoracic pacing
• sedation in the agitated pt (incl pt’s under the Mental health act 2014)
• sedation in psychostimulant OD

Question 5

Contras

Answer 5

Known hypersensitivity to benzodiazepines

Question 6

Precautions

Answer 6

• Reduced doses for elderly/frail, pt’s with chronic renal failure, CCF or shock
• CNS depressant effects of benzo’s are enhanced in the presence of narcotics and other tranquillisers incl alcohol
• can cause severe resp depression in pt’s with COPD
• pt’s with myasthenia gravis

Question 7

Route of administration

Answer 7

• IM
• IV
• IV infusion

Question 8

Side effects

Answer 8

• depressed level of consciousness
• respiratory depression
• loss of airway control
• hypotension

Question 9

IM effects

Answer 9

Onset: 3-5 mins
Peak: 15 mins
Duration: 30 mins

Question 10

IV effects

Answer 10

Onset: 1-3 mins
Peak: 10 mins
Duration: 20 mins

Question 11

Seizures

Answer 11

Generalised convulsive SE

Adult
- 10 mg IM, repeat 10 mg IM @ 10 min once only

< 60 kg / frail / elderly
- 5 mg IM, repeat 5 mg IM @ 5 min once only

Medium child (5-11 yrs)
- 2.5 - 5 mg IM, repeat initial dose @ 10 min once only

Small child (1-4 yrs)
- 2.5 mg IM, repeat initial dose @ 10 min once only

Infant (< 12 months old)
- 1 mg IM, repeat initial dose @ 10 min once only

Newborn
- 0.5 mg IM, repeat initial dose @ 10 min once only

Question 12

Agitated patient

Answer 12

Moderate agitation - SAT score +2

Adult
- 5-10 mg IM, repeat @ 10 min titrated to pt response

< 60 kg / frail / elderly / BP <100 / sedating drug / alcohol
- 2.5 - 5 mg IM, repeat @ 10 min titrated to pt response

Maximum total dose 20 mg
Consult if pt remains agitated

Consider olanzapine if pt remains agitated but becomes co-operative

Peadiactrics
- Consult clinican

Question 13

Psychostimulant OD

Answer 13

• Hyperthermic psychostimulant OD trigger point for intervention in Mx of agitation / agression is lowered.
• Sedation initiated early to assist with cooling and avoid further increases in temperature associated with agitation