midazolam Flashcards
state the class/family of drugs to which the most commonly used intravenous sedation agent belongs
Benzodiazepines
is Midazolam a trade or generic name
trade
what other name is midazolam known by
Hypnovel
is this name trade or generic
generic
what year was midazolam available in the UK
1983
state the half life of midazolam
1-4 hours. 5mg will be eliminated in 5 hours
what schedule of controlled drug is midazolam classified as
schedule III controlled drug
midazolam is available in what presentations
- 10mg in 5ml
- 10mg in 2ml
- 5mg in 5ml
from the presentations that midazolam are available in, which one should be used for best practice
5mg in 5ml
what does the blue dot on the ampoule represent
signifies the place to hold to get ease for opening
what colour is midazolam
clear liquid
how should midazolam be stored when not in use
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
what are the routes of administration of midazolam
- IV
- per-nasal
- buccally (transmucosal)
what is the PH of midazolam
3.4
state 5 advantages of using midazolam for IV sedation
- rapid onset with a pronounced effect and short acting
- it can be titrated to produce a desired effect to reflect patients individual needs
- as a patients vein is continually maintained drugs can be provided in the event of an emergency or if the patient becomes over-sedated
- patient recovery time is quicker than oral or intermuscular drugs
- reduces gag reflexes slightly
state 5 disadvantages of using midazolam for iv sedation
- venepuncture is mandatory, training is necessary to undertake venepuncture and requires great skill
- a sedation nurse is required at all times
- midazolam can cause respiratory depression and minimal cardiovascular depression
- due to rapid onset, its action and its more pronounced depression the chances of complications is elevated
- no analgesia is provided
if a patient had an allergic reaction to midazolam, how would the reaction be managed
- administration of midazolam would be stopped
- patients airway maintained
- oxygen provided
4, adrenaline administered - adrenaline IV - 0.5ML 1:10000
IM - O.5ML 1:1000
what information can be found on the midazolam ampoule
- drug name
- concentration
- batch number
- expiry date
what is the recommended titration of midazolam to a patient who is deemed ASA I
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
how is the amount of midazolam administered to a patient calculated
based on their age
what is the recommended titration of midazolam to an elderly patient
initial bolus 1-1.5mg, observe for longer than 2minutes, may not exceed 3.5mg total
why are the titrations of midazolam less and periods of observation longer for an elderly patient
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
what is the approximate onset action time for midazolam
1-3minutes
how does midazolam sedate a patient
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
what test can be undertaken to establish if a patient is sedated
eve sign (touches finger to nose with eyes closed)
what are the clinical signs of sedation using midazolam
- conscious and able to converse
- slurred speech
- impaired coordination
what are the clinical signs of over sedation using midazolam
- drowsiness
- mental confusion
- no response if asked a question
- hypotension, cardiorespiratory depression
- apnoea
- a coma
if a patient was over sedated, how would they be managed
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
how is midazolam metabolised within the body
within the liver and the gut
once midazolam is broken down, how is it excreted from the body
in urine via the kidneys
what are the clinical effects of midazolam
- Anxiolytic to reduce anxiety
- hypnotic, anticonvulsant, muscle relaxant, anterograde amnesia
- blood pressure lowered and heart rate increased
- produce sedation, slurred speech and impaired coordination
- rapid onset with a pronounced effect and short acting
state four side effects of midazolam
- respiratory depression, minimal cardiovascular effects
- hiccoughs and coughing
- headaches and drowsiness
- nausea and vomiting
state four contraindications for the use of midazolam
- pregnant or breastfeeding
- kidney or liver impairment
3, young/old patients - allergy to midazolam
- alcoholic and drug user
list as many complications as you can that can occur during IV sedation using midazolam
- over sedation
- wrong drug administered
- out of date drugs used
4, allergy to midazolam
5, venepuncture complications - cannulation becoming loose or coming out
- post -op supervision not adequate and accidents occurring
- not being fit for discharging when leaving
- escort not attending or unsuitable
if midazolam is used in conjunction with an opiate, which will be given first
opiate
