Midazolam (Versed)

Question 1

pH

Answer 1

3.5 (water soluble)

Question 2

pK

Answer 2

6.2

Question 3

E 1/2 Time

Answer 3

2 hrs; double in elderly

Question 4

Onset

Answer 4

1-2 mins

Question 5

Peak

Answer 5

• Peds PO: 20-30 min
• Adults: 5 mins

Question 6

Metabolism

Answer 6

CYP3A4; metabolized to active metabolites (1-hydroxymidazolam); have 1/2 the activity of parent molecule. Inhibit CYP450 enzymes: Increase conc. of Cimetidine, Erythromycin, Antifungals, Fentanyl, CCBs. Greater Vd in elderly, and women

Question 7

Clearance

Answer 7

Hepatic metabolism; metabolites cleared by kidneys: 5X faster than Lorazepam, 10X than Diazepam

Question 8

CNS

Answer 8

Anticonvulsant; perserves vasomotor response to CO2; doesn’t change ICP; Very Potent; cannot produce isoelectric EEG

Question 9

Resp

Answer 9

Slower; shallow. Worse in COPD. Supresses sneeze & swallow reflexes

Question 10

CV

Answer 10

Increases HR; decreases BP. CO is maintained. Decreases SVR

Question 11

Sedation Dose

Answer 11

• Peds PO: 0.25 - 0.5 mg/kg
• Adults IV: 1 - 5 mg

Question 12

Induction Dose

Answer 12

IV : 0.1 - 0.2 mg/kg over 30 - 60 secs; give with Fentanyl 50-100 mcg 1 - 3 mins prior

Question 13

Maintenance

Answer 13

Uncommon

Question 14

Post-Op GTT

Answer 14

IV gtt: 1 - 7 mg/hr. Prolonged gtt > 3 days: T-cell Suppression