Midazolam

Question 1

Pharmacology and presentation

Answer 1

15mg:3ml

• Benzodiazepine that enhances the activity of GABA at it’s receptors within the central nervous system. Resulting in anticonvulsant activity, sedation, amnesia, anxiolysis and muscle relaxation.

Question 2

Indicators of Midazolam?
7

Answer 2

• Prolonged seizures.
• Agitated delirium causing a mild to moderate risk to safety and droperidol is unavailable or ineffective.
• Pain associated with severe muscle spasm or anxiety if adequate analgesia is not being achieved with opiate or ketamine.
• Sedation, for example for joint relocation.
• Sedation post intubation.
• Severe anxiety associated with COPD.
• Control of anxiety in End of life Care with no response from opiates

Question 3

Contraindications of Midazolam?

Answer 3

• Known severe allergy
• Age less than 12 Y/O (Analgesic only)

Question 4

Cautions of Midazolam?

Answer 4

• ALOC
• Respiratory Depression or at high risk of Respiratory Depression.
• Signs of Shock
• Concurrent administration of opiates, ketamine or other sedatives.
• Elderly and/or frail.

Question 5

Side Effects of Midazolam?
RASH

Answer 5

• Sedation.
• Respiratory depression.
• Hypotension.
• Amnesia.

Question 6

Dosing Regimes of Midazolam?

Answer 6

Adult Seizures IV (dilute to 10mg:10ml)
- 5mg IV, repeat once at 5mins (3mg if small, elderly, frail or physiologically unstable)

Adult Seizures IM
- 10mg IM, repeat once at 10mins (5mg if small, elderly, frail or physiologically unstable)

Adult Agitated Delirium IM
- 10mg IM, repeat once at 20mins (5mg if small, elderly, frail or physiologically unstable)

Adult Agitated Delirium IV
- 2mg - 3mg every 5min as required (Reduce the dose to 1mg - 2mg if small, elderly or frail)

Adult End of life Care IV
- 1mg - 2mg

Adult End of life care IM/SC
- 2.5mg - 5 mg

Question 7

Onset and duration of Midazolam?

Answer 7

Onset:
- IV: 2-3 mins.
- IM: 3-5 mins

Duration
- 30-60mins