Midazolam Flashcards

1
Q

Presentation

A

5 mg in 1 ml glass ampoule

15 mg in 3 ml glass ampoule

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2
Q

Pharmacology

A

Short acting CNS depressant

Actions:

  • Anxiolytic
  • Sedative
  • Anti-convulsant
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3
Q

Metabolism

A
  • in the liver

- excreted by the kidneys

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4
Q

Indications

A
  • 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
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5
Q

Contras

A

Known hypersensitivity to benzodiazepines

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6
Q

Precautions

A
  • 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
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7
Q

Route of administration

A
  • IM
  • IV
  • IV infusion
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8
Q

Side effects

A
  • depressed level of consciousness
  • respiratory depression
  • loss of airway control
  • hypotension
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9
Q

IM effects

A

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

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10
Q

IV effects

A

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

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11
Q

Seizures

A

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

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12
Q

Agitated patient

A

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

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13
Q

Psychostimulant OD

A
  • 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
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