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dental nurse sedation > midazolam > Flashcards

midazolam Flashcards

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1
Q

state the class/family of drugs to which the most commonly used intravenous sedation agent belongs

A

Benzodiazepines

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2
Q

is Midazolam a trade or generic name

A

trade

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3
Q

what other name is midazolam known by

A

Hypnovel

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4
Q

is this name trade or generic

A

generic

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5
Q

what year was midazolam available in the UK

A

1983

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6
Q

state the half life of midazolam

A

1-4 hours. 5mg will be eliminated in 5 hours

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7
Q

what schedule of controlled drug is midazolam classified as

A

schedule III controlled drug

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8
Q

midazolam is available in what presentations

A
  • 10mg in 5ml
  • 10mg in 2ml
  • 5mg in 5ml
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9
Q

from the presentations that midazolam are available in, which one should be used for best practice

A

5mg in 5ml

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10
Q

what does the blue dot on the ampoule represent

A

signifies the place to hold to get ease for opening

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11
Q

what colour is midazolam

A

clear liquid

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12
Q

how should midazolam be stored when not in use

A

in a controlled drugs cabinet which is metal, locked and fixed to the wall. 2 people have access to sign in and out. Records and documentation to be kept for up to 2 years

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13
Q

what are the routes of administration of midazolam

A
  • IV
  • per-nasal
  • buccally (transmucosal)
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14
Q

what is the PH of midazolam

A

3.4

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15
Q

state 5 advantages of using midazolam for IV sedation

A
  1. rapid onset with a pronounced effect and short acting
  2. it can be titrated to produce a desired effect to reflect patients individual needs
  3. as a patients vein is continually maintained drugs can be provided in the event of an emergency or if the patient becomes over-sedated
  4. patient recovery time is quicker than oral or intermuscular drugs
  5. reduces gag reflexes slightly
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16
Q

state 5 disadvantages of using midazolam for iv sedation

A
  1. venepuncture is mandatory, training is necessary to undertake venepuncture and requires great skill
  2. a sedation nurse is required at all times
  3. midazolam can cause respiratory depression and minimal cardiovascular depression
  4. due to rapid onset, its action and its more pronounced depression the chances of complications is elevated
  5. no analgesia is provided
17
Q

if a patient had an allergic reaction to midazolam, how would the reaction be managed

A
  1. administration of midazolam would be stopped
  2. patients airway maintained
  3. oxygen provided
    4, adrenaline administered
  4. adrenaline IV - 0.5ML 1:10000
    IM - O.5ML 1:1000
18
Q

what information can be found on the midazolam ampoule

A
  1. drug name
  2. concentration
  3. batch number
  4. expiry date
19
Q

what is the recommended titration of midazolam to a patient who is deemed ASA I

A

initial bolus of 2mg over 30 seconds, observe for 2minutes, 0.5 - 1mg until level of sedation is reached, usual dose between 2.5mg and 7.5mg

20
Q

how is the amount of midazolam administered to a patient calculated

A

based on their age

21
Q

what is the recommended titration of midazolam to an elderly patient

A

initial bolus 1-1.5mg, observe for longer than 2minutes, may not exceed 3.5mg total

22
Q

why are the titrations of midazolam less and periods of observation longer for an elderly patient

A

elderly patients are more sensitive to midazolam as the arm brain time is much slower. They can over sedate quicker, It takes longer for the initial bolus to reach the brain

23
Q

what is the approximate onset action time for midazolam

A

1-3minutes

24
Q

how does midazolam sedate a patient

A

Provides conscious sedation by acting on the CNS, reducing the excitability of neurones in the mid brain. Benzodiazepines receptors are parallel to inhibitory neurotransmitters. When midazolam attaches to the benzodiazepine receptors they enhance the effect of the inhibitory neurotransmitters. This occurs as a brain chemical that is naturally calming, enhancing the effects of the GABA resulting in either the slowing down or stopping of certain nerve signals within the brain

25
Q

what test can be undertaken to establish if a patient is sedated

A

eve sign (touches finger to nose with eyes closed)

26
Q

what are the clinical signs of sedation using midazolam

A
  1. conscious and able to converse
  2. slurred speech
  3. impaired coordination
27
Q

what are the clinical signs of over sedation using midazolam

A
  1. drowsiness
  2. mental confusion
  3. no response if asked a question
  4. hypotension, cardiorespiratory depression
  5. apnoea
  6. a coma
28
Q

if a patient was over sedated, how would they be managed

A

careful observation of the patients vital signs if necessary along with the airway maintenance and provision of oxygen. The benzodiazepine antagonist FLUMAZENIL (Anexate) will be used. If necessary, CPR and ambulance called

29
Q

how is midazolam metabolised within the body

A

within the liver and the gut

30
Q

once midazolam is broken down, how is it excreted from the body

A

in urine via the kidneys

31
Q

what are the clinical effects of midazolam

A
  1. Anxiolytic to reduce anxiety
  2. hypnotic, anticonvulsant, muscle relaxant, anterograde amnesia
  3. blood pressure lowered and heart rate increased
  4. produce sedation, slurred speech and impaired coordination
  5. rapid onset with a pronounced effect and short acting
32
Q

state four side effects of midazolam

A
  1. respiratory depression, minimal cardiovascular effects
  2. hiccoughs and coughing
  3. headaches and drowsiness
  4. nausea and vomiting
33
Q

state four contraindications for the use of midazolam

A
  1. pregnant or breastfeeding
  2. kidney or liver impairment
    3, young/old patients
  3. allergy to midazolam
  4. alcoholic and drug user
34
Q

list as many complications as you can that can occur during IV sedation using midazolam

A
  1. over sedation
  2. wrong drug administered
  3. out of date drugs used
    4, allergy to midazolam
    5, venepuncture complications
  4. cannulation becoming loose or coming out
  5. post -op supervision not adequate and accidents occurring
  6. not being fit for discharging when leaving
  7. escort not attending or unsuitable
35
Q

if midazolam is used in conjunction with an opiate, which will be given first

A

opiate

dental nurse sedation (3 decks)

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