Midazolam

Question 1

Presentation

Answer 1

1. 5mg in 1ml

2. 15mg in 3ml

Question 2

Indications

Answer 2

1. Sedation for agitation
2. SE
3. Sedation for intubation
4. sedation to maintain ETT
5. Sedation for cardioversion
6. Sedation for pacing
7. Sedation for psychostimulant OD

Question 3

Contraindications

Answer 3

1. Known hypersensitivity to benzodiazepines

Question 4

Precautions

Answer 4

1. Reduced doses for elderly/frail with chronic renal failure, CCF or shock
2. The CNS depressant effects are enhanced in the presence of narcotics and other tranquillisers including alcohol
3. May cause severe respiratory depression in COPD pts
4. Pts with myasthenia Gravis

Question 5

Side effects

Answer 5

1. Decreased level of consciousness
2. Loss of airway control
3. Respiratory depression
4. Hypotension

Question 6

Pharmacology

Answer 6

Midazolam is a positive allosteric modulator which works by binding to the allosteric site of GABBA receptors allowing GABBA to work better. It is also allows chloride channels to stay open longer allowing more chloride into the cell causing it to be hyperpolarised making it more difficult for action potentials to reach their threshold this ceasing the excessive brain activity

Question 7

IV Effects

Answer 7

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

Question 8

IM effects

Answer 8

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