Midazolam Hydrochloride

Question 0

Drug classification (2)

Answer 0

1. Anticonvulsant

2. Sedative/hypnotic (a benzodiazepine)

Question 1

Trade name (2)

Answer 1

Versed

Hypnovel

Question 2

Actions (3)

Answer 2

1. Depresses the central nervous system
2. Relaxes skeletal muscle
3. Decreases patient recall (amnesic effect in intubation or cardioversion)

Question 3

Indications (5)

Answer 3

1. Suppression of seizure activity
2. Sedation prior to cardioversion or TC pacing
3. Facilitate intubation
4. Agitated delirium
5. Prevent/suppress seizure caused by organophosphate (nerve agent) poisoning

Question 4

Contraindication (4)

Answer 4

1. Infants less than 6 months old
2. Shock/hypotension
3. Glaucoma
4. Patients known to be taking
   - calcium channel blockers
   - AIDS medication
   - Anti-Fungal medications

Question 5

Relative Contraindication (2)

Answer 5

1. Head injury

2. Alcohol intoxication/Narcotic Ingestion

Question 6

Adverse effects - cardiovascular (4)

Answer 6

Bradycardia
Tachycardia*
Hypotension*
PVCs*

Question 7

Adverse effects - Respiratory (5)

Answer 7

Cough/Dyspnea
Depression, apnea*
Laryngospasm*
Bronchospasm*
Respiratory arrest*

Question 8

Adverse effects - Neurological (5)

Answer 8

1. Drowsiness*
2. Amnesia*, confusion
3. Blurred vision*
4. Headache
5. Restlessness

Question 9

Adverse effects - Gastrointestinal (3)

Answer 9

Nausea/vomiting
Hiccups
Increased salivation

Question 10

Adverse effects - general (2)

Answer 10

Pain during injection

Phlebitis

Question 11

Administration - sedation for Cardioversion or TCP

Answer 11

1-2 mg SLOW IVP at 1mg/min. Titrate to produce sedation

2.5 mg IM or IN

Max total dose is 10 mg

Question 12

Administration - seizures

Answer 12

2-5 mg SLOW IVP at 1mg/min. Titrate ti suppress seizure activity.

May repeat IVP every 3-5min. PRN.

5 mg IM or IN. May repeat IM or IN dose one time in 5 min.

Maximum total dose 10 mg.

Question 13

Administration - Agitated Delirium

Answer 13

2-5 mg SLOW IVP at 1mg/min. Titrate until sedation occurs.

5 mg IM or IN. May repeat IM or IN dose one time.

Maximum total dose is 10 mg.

Question 14

Pediatrics - seizures

Answer 14

0.1 mg/kg SLOW IVP at 1 mg/min. Titrate IV dose to suppress seizure activity.

Or 0.1 mg/kg IM or IN. May repeat IVP/IM/IN dose one time PRN

Maximum total dose is 5 mg

Question 15

Pediatrics - sedation for Cardioversion

Answer 15

0.1 mg/kg SLOW IVP at 1 mg/min or 0.1 mg/kg IM or IN

Titrate IV dose to produce sedation. May repeat IVP/IM/IN dose every 3-5 minutes

Maximum total dose 5 mg.

Question 16

Onset

Answer 16

IVP = 1-5 minutes
IM = 10-15 minutes
IN = 10 minutes

Question 17

Duration

Answer 17

2-4 hours

Question 18

Precaution

Monitor respiratory and cardiac status and prepare to support airway, ventilation, and circulation PRN

Answer 18

Rationale

Midazolam is 3-4 times more potent than diazepam (3mg midazolam = 10 mg diazepam)

Question 19

Precaution

Monitor respiratory status and prepare to support airway and ventilation. BVM and OP airway should be immediately available.

Answer 19

Rationale

There is a significant risk of respiratory depression or arrest and airway obstruction due to laryngeal and bronchial spasm, especially in COPD patients.

Question 20

Precaution

Continuous pulse oximetry

Answer 20

Rationale

Monitor for hypoventilation

Question 21

Precaution

Administer only one-half the recommended dose to debilitated patients and patients > 60 years of age

Answer 21

Rationale

Decreased hepatic metabolism prolongs the sedative effects in patients with liver or kidney disease and patients taking AIDS medication

Question 22

Note

Answer 22

The contraindication listed for Relative only in the event of seizure activity in the prehospital setting. However, these contraindications should be seriously considered when midazolam is to be given for sedation.

Action of midazolam is potentials when patients are taking verapamil, diltiazem, effects may result in potentially life-threatening respiratory depression or dysrhythmias

Antidote to reverse respiratory depression is Romazicon (flumazenil)

There is an increased risk of digoxin toxicity because of hypokalemia

Pediatrics oatients may require higher doses than adults, and children less than 6 years of age require higher doses than the 6-12 year age group

Infants less than 6 months of age are unable to metabolize midazolam due to liver immaturity and may experience severe respiratory depression

Midazolam is a Schedule IV medication and will have additional storage and record-keeping requirements

Question 23

How supplied

Answer 23

1 mg/mL and 5 mg/ml preparation
1 mg/mL preparation = 0.1 mg/0.1 mL
5 mg/mL preparation = 0.5 mg/0.1 mL