Midazolam CPG

Question 1

Midazolam - Presentation

Answer 1

5 mg in 1 mL glass ampoule

15 mg in 3 mL glass ampoule

Question 2

Midazolam - Pharmacology

Answer 2

Short acting CNS depressant

Actions:

• Anxiolytic
• Sedative
• Anti-convulsant

Question 3

Midazolam - Metabolism

Answer 3

In the liver; excreted by the kidneys

Question 4

Midazolam - Primary emergency indications

Answer 4

1. Status epilepticus

2. Sedation to enable intubation (RSI/IFS)
3. Post Intubation Sedation
4. Sedation to facilitate synchronised cardioversion
5. Sedation to facilitate transthoracic pacing

6. Sedation in the agitated patient (including patients under the mental health act 2014)

7. Sedation in psychostimulant OD

Question 5

Midazolam - Contraindications

Answer 5

1. Known hypersensitivity to benzodiazepines

Question 6

Midazolam - Precautions

Answer 6

1. Reduced doses may be required for the elderly/frail, patients with chronic renal failure, CCF or shock
2. The CNS depressant effects of benzodiazepines are enhanced in the presence of narcotics and other tranquilizers including alcohol
3. Can cause severe respiratory depresion in patients with COPD
4. Patients with myasthenia gravis

Question 7

Midazolam - Route of administration

Answer 7

IM

IV

IV infusion

Question 8

Midazolam - Side effects

Answer 8

Depressed level of conciousness

Respiratory depression

Loss of airway control

Hypotension

Question 9

Midazolam - Special notes

Answer 9

IM effects:

Onset: 3 - 5 min

Peak: 15 min

Duration: 30 min

IV effects:

Onset: 1 - 3 min

Peak: 10 min

Duration: 20 min