Midazolam/ Versed

Question 1

Midazolam Class

Answer 1

• Benzodiazepine (nonbarbiturate sedative-hypnotic agent)

* Schedule IV Controlled Substance

Question 2

Midazolam Action

Answer 2

• Acts at the level of the limbic, thalamic, and hypothalamic regions of the CNS through potentiation of GABA (inhibitory neurotransmitter).
• Decreases neural cell activity in all regions of CNS
• Anxiety is decreased by inhibiting cortical and limbic arousal
• Promotes relaxation through inhibition of spinal motor reflex pathway, also depresses muscle and motor nerve function directly
• As an anticonvulsant, augments presynaptic inhibitions of neurons, limiting the spread of electrical activity. However, it does not alter the electrical activity of the seizure’s focus
• Midazolam has twice the affinity for benzodiazepine receptors than does diazepam and has more potent amnesic effects
• It is short acting and roughly 3-4 times more powerful than diazepam

Question 3

Midazolam Indications

Answer 3

• Sedation prior to cardioversion and intubation
• Maintenance of sedation in mechanically ventilated patients
• Seizure control in pediatrics

Question 4

Midazolam Contraindications

Answer 4

• Shock
• Coma
• Hypersensitivity
• Pregnancy (D)
• Closed Angle Glaucoma

Question 5

Midazolam Precautions

Answer 5

• Patients with respiratory insufficiency (asthma, COPD, etc.) are more susceptible to respiratory depression.
• Effects are enhanced by other CNS depressants.
• Elderly
Use caution when administering to patients with:
• Hepatic dysfunction
• Renal insufficiency
• History of drug addiction
• Parkinson’s Disease
• Myasthenia gravis

Question 6

Midazolam Dosage

Answer 6

Adults:
• Intubation: IV/IM: IV: 0.5-5 mg, repeat q 5-10 min PRN, Max of 10 mg.
• Status epilepticus, cardioversion and pacing, inner ear s/s, sedation, and muscular spasms: IV: 0.5-2.5 mg, repeat q 5-10 min PRN, Max of 5 mg. IM: 5 mg (If no vascular access) Max dose of 5 mg.
Pediatrics:
• Intubation: 0.1-0.2 mg/kg to a max of 5 mg/dose.
• Repeat PRN for ongoing sedation to a max of 10 mg.
• Seizures: IN/IM: 0.2 mg/kg repeat q 5 min PRN. Max 10 mg. IV/IO: 0.1 mg/kg q 5 –10 min PRN. Max 5 mg.
• Sedation for painful procedures, cardioversion, pacing,
muscular spasms, hyperdynamic drug ingestion/exposure: IV/IO/IM: 0.05-0.1 mg/kg q 5-10 min (over 2-5 minutes if IV). Max dose of 2.5 mg IN: 0.2 mg/kg q 5-10 min. Max dose 2.5 mg. (Not for children under 2 yrs).

Question 7

Midazolam Onset/ Duration

Answer 7

• Onset: IV: 1-3 min(dose dependent) IN: 1-5 min (dependent on nasal structures)
• Duration: IV: 2-6 hours (dose dependent)

Question 8

Midazolam Side Effects

Answer 8

Minor:
• N/V
• Headache
• Drowsiness
• Lethargy
• Cough
• Hiccups
Major:
• Respiratory Depression
• Apnea
• Hypotension
• Cardiac Arrest
• Paradoxical CNS stimulation (i.e. Valium Rage)

Question 9

Midazolam Interactions

Answer 9

Additive with other CNS depressants