Midazolam

Question 1

Brand name

Answer 1

versed

Question 2

classification

Answer 2

benzo

Question 3

mechanism of action

Answer 3

potentiates binding of GABA to the GABA-A receptor, keeping the Cl- channels open and hyperpolarizing the cell, making it resistant to excitation

Question 4

structure

Answer 4

water soluble imidazole ring

Question 5

pharmacokinetics
PB
lipid solubility
VD
elimination

Answer 5

90-98% PB
highly Lipid soluble (rapidly crosses BBB)
VD - 1-1.5L/Kg (large)
elimination: CYP450, excreted urine

Question 6

pharmacokinetics
onset
doa
T1/2

Answer 6

onset - 30-60 sec
doa - 15-80 min
T1/2 - 1-4 hrs, redose in 5 min

Question 7

active metabolite

Answer 7

1-hydroxy midazolam (1/2 as potent)

Question 8

side effects

Answer 8

lowers CBF and CMRO2
no isoelectric EEG
preserves CO2 response but flattens curve
neuroprotective

decreased SVR, BP at induction
NO CHANGE TO CO, (relatively stable)
does NOT attenuate SNS response to DVL

dose dependent decrease RR and TV if given with opioids
can cause paradoxical excitation

Question 9

contraindications

Answer 9

pregnancy
decrease dose in hepatic/renal pts
caution w/ elderly
synergistic with opioids
DO NOT give with glaucoma

Question 10

dose

Answer 10

Pre-med - 1-2.5 mlg IV max 5; 0.5 mg/kg PO max 20

induction - 0.1-0.2 mg/kg over 30-60 sec