QAS Midazolam DTP

Comprehensive vocabulary and protocol flashcards covering Queensland Ambulance Service guidelines for midazolam, including pharmacology, indications, precautions, pharmacokinetic properties, clinical administration routes, and adult and paediatric dosing regimens.

Drug class

A short acting benzodiazepine.

Pharmacology

A short acting CNS depressant that induces amnesia, anaesthesia, hypnosis, and sedation by enhancing the action of the inhibitory neurotransmitter gamma-amino butyric acid (GABA), producing depressant effects at all levels of the CNS.

Metabolism

Metabolised by the liver and excreted by the kidneys.

Indications

1. Generalised seizures or focal seizure (GCS equal or less than 12)

2. Sedation (maintenance of an established SAD/ETT

3. Procedures such as TCP or cardioversion

4. CPR-induced consciousness

5. Safe assessment and treatment of agitated head-injured patients

6. Adjunct to opiate analgesia

7. Ketamine emergence

8. cute behavioural disturbance (SAT score equal or greater than 2) unresponsive to maximum dose droperidol.

Contraindications

Allergy and/or adverse drug reaction.

Precautions

1. Requires reduced dosage consideration in low body weight, older, cachectic, or frail patients, and patients with chronic renal failure

2. Congestive cardiac failure, or shock

3. Can cause severe respiratory depression in patients with COPD

4. Caution in myasthenia gravis and multiple sclerosis.

Side Effects

Hypotension and respiratory depression, particularly when associated with other CNS depressants including alcohol and narcotics.

Presentation

Ampoule containing 5mg/1ml midazolam

Pharmacokinetics

Onset: 5-15 minutes (IM) and 1-3 minutes (IV)

Duration: variable

Elimination half-life is 2.5 hours

Adult Doses

NAS/IM: 5mg repeated every 10 minutes to a total max dose of 20mg (seizure)

IV/IO: 5mg repeated every 5 minutes to a total max dose of 20mg (seizure)

IV/IO: 1-2.5mg , repeated every 3-5 minutes with no max dose; should be avoided in significant hypovolaemia (sedation)

IM/IV: Consult for all cases (ABD)

Adult Dosage: Generalised / Focal Seizure (IV/IO)

$5\text{ mg}$, repeated every $5\text{ minutes}$ to a total maximum dose of $20\text{ mg}$ (IV authorised for ACP2 and CCP; IO authorised for CCP).

Paediatric doses

NAS/IM: 200microg/kg with a single dose not to exceed 5mg, repeated at half the initial dose (maximum 2.5mg) at 10 minute intervals to a total maximum dose of 10mg (seizures)

IV/IO: 100microg/kg with a single dose not to exceed 2.5mg, repeated at 5 minute intervals, max dose 10mg. (seizures)

IV/IO: Up to 100microg/kg, single dose not to exceed 2.5mg, repeated at 3-5 minute intervals, total max dose 5mg (sedation)

IM/IV: consult for all cases (ABD)