Midazolam Flashcards
Presentation
5 mg in 1 ml glass ampoule
15 mg in 3 ml glass ampoule
Pharmacology
Short acting CNS depressant
Actions:
- Anxiolytic
- Sedative
- Anti-convulsant
Metabolism
- in the liver
- excreted by the kidneys
Indications
- 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
Contras
Known hypersensitivity to benzodiazepines
Precautions
- 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
Route of administration
- IM
- IV
- IV infusion
Side effects
- depressed level of consciousness
- respiratory depression
- loss of airway control
- hypotension
IM effects
Onset: 3-5 mins
Peak: 15 mins
Duration: 30 mins
IV effects
Onset: 1-3 mins
Peak: 10 mins
Duration: 20 mins
Seizures
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
Agitated patient
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
Psychostimulant OD
- 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