Midazolam

Question 1

What is the trade name for midazolam?

Answer 1

Versed

Question 2

What is the drug classification of midazolam (Versed)?

Answer 2

benzodiazepine

Question 3

How is midazolam (Versed) supplied?

Answer 3

In a 1 mg/mL or 5 mg/mL multi-dose vial

Question 4

Describe the MOA (pharmacodynamics) of midazolam (Versed).

Answer 4

Enhances action of GABA (a majour inhibitory neurotransmitter) in the brain which produces anxiolytic, hypnotic, anticonvulsant, muscle relaxant, and amnestic effects.

Question 5

What are the indications for the use of midazolam (Versed)?

Answer 5

• Seizures (status epilepticus, pre-eclampsia/eclampsia)
• Sedation (cardioversion, pacing, fracture realignment, muscle spasms (with analgesia medication)
• Severely anxious or agitated patients, stimulants, non-cyclic antidepressants, excited delirium syndrome
• Maintenance of sedation for intubated and mechanically ventilated patients
• Sedation prior to intubation in conjunction with fentanyl (MFI)

Question 6

What is the dose of midazolam (Versed) for conscious sedation?

Answer 6

Max dose 2.5 to 5mg (0.05 - 0.1mg/kg) IV q 5 – 10 min.

Muscle Spasm dose is usually 1 - 2mg. If unable to get IV then give 5 - 10mg IM

Question 7

What is the dose of midazolam (Versed) to treat seizures?

Answer 7

Max dose 5mg (0.05 - 0.1mg/kg) SIVP or 10mg IM once.

Use lower dose for patients >65 yrs. of age or pts with smaller body mass.

Max dose 10mg IN (0.2mg/kg), no repeat. Primarily used for pediatric seizures and sedation.

Question 8

What is the dose of midazolam (Versed) in maintenance of sedation for intubation?

Answer 8

Max dose 5mg SIVP (0.2 - 0.5mg/kg), q 5 - 10min prn

Infusion: 1 - 7mg/hr, titrated to the desired amount of sedation. Used for transports 30+ minutes

Question 9

What is the dose of midazolam (Versed) for MFI?

Answer 9

Max single dose of 5mg (0.2 - 0.3mg/kg) IVP with an opioid (if systolic BP <90mmHg; use ketamine)

Question 10

What are the contraindications for midazolam (Versed)?

Answer 10

• Hypersensitivity
• Acute narrow angle glaucoma
• Acute alcohol intoxication

Question 11

What are some precautions to consider for the use of midazolam (Versed)?

Answer 11

• Use cautiously/lower dosing in elderly or debilitated patients or those patients with impaired renal or hepatic function or hypotension.
• If patient becomes agitated, hyperactive, or combative after initial dose select another agent

Question 12

How should you mix a midazolam (Versed) infusion?

Answer 12

Mix 50mg in 100ml NS, making the concentration 2mg/ml. Give as per protocol.

Question 13

What IV solutions are compatible with midazolam (Versed)?

Answer 13

D5W, Normal Saline and Lactated Ringer’s are all compatible with midazolam

Question 14

What should you always have ready prior to administration of midazolam (Versed)?

Answer 14

Always have resuscitation equipment out and available; monitor vital signs closely

Question 15

Can midazolam (Versed) cause post airway intervention hypotension?

Answer 15

YES. Even when used appropriately, midazolam can induce post airway intervention hypotension; treat with fluid boluses.