Midazolam (Versed) Flashcards
Actions
- Depresses CNS
- Relaxed skeletal muscles
- Decreases PT recall
Classification
Anticonvulsant
Sedative/hypnotic
Indications
- Suppression of seizure activity
- Sedation prior to cardioversion or TC pacing
- Facilitate intubation
- Agitated delirium
- Prevent/suppress seizure caused by organophosphate poisoning
Contraindications
- Infant < 6 months old
- Shock/ hypotension
- Glaucoma
- Pt’s taking calcium channel blockers
- AIDS meds, anti-fungal meds
Relative contraindications
- Head Injury
2. ETOH / narcotic ingestion
Adverse effects
CARDIO- bradycardia, tachycardia, hypotension, pvc’s
RESP- cough/dyspnea, depression, apnea, laryngospasm, bronchospasm, respiratory arrest
NEURO- drowsiness, amnesia, confusion, blurred vision, headache, restlessness
G/I- n/v, hiccups, ⬆️ salivation
OTHER- pain during injection, phlebitis
Administration:
Sedation for cardioversion or TC pacing
1-2mg slow (1mg/min) IVP
Titrate to produce sedation.
2.5mg IM or IN
Max total dose 10mg
Administration:
Seizures
2-5mg slow (1mg/min) IVP
Titrate to suppress seizure activity
May repeat every 3-5 min. PRN
5mg IM or IN
May repeat one time in 5 min.
Max total dose 10mg
Administration:
Agitated Delirium
2-5mg slow (1mg/min) IVP
Titrate until sedation occurs
5mg IM or IN
May repeat one time in 5 min.
Max total dose 10mg
PEDS ADMINISTRATION:
Seizures
0.1 mg/kg slow (1mg/min) IVP
0.1 mg/kg IM or IN
Titrate to suppress seizure activity.
May repeat IVP/IM/IN one time PRN
Max total dose 5mg
PEDS ADMINISTRATION:
Sedation for Cardioversion
0.1 mg/kg slow (1mg/min.) IVP
0.1 mg/kg IM or IN
May repeat IVP/IM/IN dose every 3-5min.
Max total 5mg
Onset
1-5min. IVP
10-15min. IM
10min. IN
Duration
2-4 hours
Which drugs is Midazolam potentiated with?
Verapamil Diltiazem Ketoconazole Itraconazole Narcotics ETOH
What schedule is Midazolam?
Schedule IV
What is the antidote to reverse respiratory depression?
Romazicon (flumazenil)
Why can Midazolam not be given to infants < 6 months old?
Unable to metabolize Midazolam due to liver immaturity and may experience severe respiratory depression.
Who may require higher doses of Midazolam?
Pediatrics may require higher doses than adults and peds < 6 y/o may require higher doses than peds 6-12y/o
What should be monitored?
Respiratory & cardiac status
Who should receive half dose?
Debilitated patients
&
Patients > 60 y/o
Why do elderly and debilitated patients receive half doses?
Decreased hepatic metabolism prolongs the sedative effects in patients with liver or kidney disease.
Also in patients taking AIDS meds.
Reference # 806
ADULT: 2-5mg slow IVP Titrate to control seizure activity. 5mg IM/IN if unable to establish IV May repeat 1 time in 5 min. Max dose 10mg all routes
PEDS: Up to 0.1 mg/kg IVP Titrate to control seizure activity 0.1mg/kg IM/IN if unable to est. IV May repeat 1 time in 5 min. Max dose 5mg all routes
