Midazolam Hydrochloride

Question 1

Generic Name:

Answer 1

Midazolam Hydrochloride

Question 2

Trade Name:

Answer 2

Versed

Question 3

Supplied:

Answer 3

10mg/2mL vial

Question 4

Class:

Answer 4

CNS depressant, Benzodiazepine, Sedative

Question 5

Mechanism of Action:

Answer 5

•  CNS effects are mediated through the inhibitory neurotransmitter gamma-aminobutyric acid (GABA).
•  Acts at the limbic, thalamic, and hypothalamic levels of the CNS, producing anxiolytic, sedative, hypnotic, and anticonvulsant effects.
•  Capable of producing all levels of CNS depression, from mild sedation to coma.

Question 6

Indications and Field Use:

Answer 6

• Anti-confulsant
• Sedation
• Management of acute agitation/excited delirium (treat cause as well, if possible)
• Induction for intubation

Question 7

Contraindications:

Answer 7

- Hypersensitivity to midazolam

•  Relative contraindication in: Myasthenia gravis or other neuromuscular disorders; acute alcohol intoxication; severe, chronic obstructive pulmonary disease; and acute pulmonary insufficiency
•  Pregnancy (relative)

Question 8

Adverse Reactions:

Answer 8

CV: Hypotension (especially in patients premedicated with narcotic); cardiac arrest; irregular or fast heartbeat

Resp: Apnea; respiratory depression, respiratory arrest; paradoxical hyperventilation; wheezing or difficulty in breathing; hiccups; coughing

CNS: Emergence delirium; muscle tremor; uncontrolled or jerky movements of body; unusual excitement, irritability, or restlessness; dizziness, light-headedness, or feeling faint; prolonged drowsiness; headache

GI: Nausea and/or vomiting

Question 9

Notes on Administration:

Answer 9

Midazolam administered intravenously has been associated with respiratory depression and respiratory arrest, especially when used concomitantly with opioid analgesics for conscious sedation or when rapidly administered. Midazolam may cause phlebitis. May need to adjust midazolam dose down for patients on erythromycin.

Question 10

Incompatibilities/Drug Interactions:

Answer 10

Midazolam may potentiate the action of other CNS depressants, including opiate agonists or other analgesics, barbiturates or other sedatives, anesthetics, or alcohol.

Question 11

Adult Dosage: Patients 14 to 60 years of age:

Answer 11

• 2 to 5 mg IM
• 1 to 10 mg IV/IO, titrate to effect, administer slowly in small increments of no more than 2.5 mg over at least 2 minutes.

Question 12

Adult Dosage: Patients over 60 years of age:

Answer 12

• 1 to 5 mg IM
• 1 to 3.5 mg IV/IO, titrate to effect, administer slowly in small increments of no more than 1.5 mg over at least 2 minutes.

Question 13

Total Dose:

Answer 13

Should not exceed 20 mg

Question 14

For Emergency Intubation:

Answer 14

• 0.1 mg/kg up to 0.3 mg/kg with dosage limit of 20 mg.
• 0.2 mg/kg IM if no IV/IO access
• 0.3 mg/kg IN (divided equally into each nostril) if no IV/IO access

Question 15

Pediatric Dosage:

Answer 15

• 0.05 to 0.1 mg/kg slow IV/IO push
• 0.2 mg/kg IM/IN if no IV/IO access
  (IN dose divided equally in each nostril)

Question 16

Routes of Administration:

Answer 16

•  For IM administration, inject deep into large muscle mass.
•  For IV bolus and infusion, administer slowly in small increments over at least 2 minutes and allow 2 more minutes between doses to evaluate effect.
•  For IN administration, use only concentrated Midazolam (5mg/ml). Ideal volume is 0.3-
  0. 5 ml per nostril, maximum is 1ml per nostril. More volume will just run out of nose. Be aware Midazolam causes some nasal burning for 30-45 seconds when administered.

Question 17

Onset of Action:

Answer 17

IM - 15 minutes

IV/IO - Immediate

Question 18

Peak Effects:

Answer 18

IM - 15 to 60 minutes

IV - 3 to 5 minutes

Question 19

Duration of Action:

Answer 19

2 to 6 hours

Question 20

Arizona Drug Box Minimum Supply:

Answer 20

10 mg