Midazolam (Versed)

Question 0

Actions

Answer 0

1. Depresses CNS
2. Relaxed skeletal muscles
3. Decreases PT recall

Question 1

Classification

Answer 1

Anticonvulsant

Sedative/hypnotic

Question 2

Indications

Answer 2

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 poisoning

Question 3

Contraindications

Answer 3

1. Infant < 6 months old
2. Shock/ hypotension
3. Glaucoma
4. Pt’s taking calcium channel blockers
   
   • AIDS meds, anti-fungal meds

Question 4

Relative contraindications

Answer 4

1. Head Injury

2. ETOH / narcotic ingestion

Question 5

Adverse effects

Answer 5

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

Question 6

Administration:

Sedation for cardioversion or TC pacing

Answer 6

1-2mg slow (1mg/min) IVP
Titrate to produce sedation.

2.5mg IM or IN

Max total dose 10mg

Question 7

Administration:

Seizures

Answer 7

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

Question 8

Administration:

Agitated Delirium

Answer 8

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

Question 9

PEDS ADMINISTRATION:

Seizures

Answer 9

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

Question 10

PEDS ADMINISTRATION:

Sedation for Cardioversion

Answer 10

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

Question 11

Onset

Answer 11

1-5min. IVP
10-15min. IM
10min. IN

Question 12

Duration

Answer 12

2-4 hours

Question 13

Which drugs is Midazolam potentiated with?

Answer 13

Verapamil
Diltiazem
Ketoconazole
Itraconazole 
Narcotics
ETOH

Question 14

What schedule is Midazolam?

Answer 14

Schedule IV

Question 15

What is the antidote to reverse respiratory depression?

Answer 15

Romazicon (flumazenil)

Question 16

Why can Midazolam not be given to infants < 6 months old?

Answer 16

Unable to metabolize Midazolam due to liver immaturity and may experience severe respiratory depression.

Question 17

Who may require higher doses of Midazolam?

Answer 17

Pediatrics may require higher doses than adults and peds < 6 y/o may require higher doses than peds 6-12y/o

Question 18

What should be monitored?

Answer 18

Respiratory & cardiac status

Question 19

Who should receive half dose?

Answer 19

Debilitated patients
&
Patients > 60 y/o

Question 20

Why do elderly and debilitated patients receive half doses?

Answer 20

Decreased hepatic metabolism prolongs the sedative effects in patients with liver or kidney disease.
Also in patients taking AIDS meds.

Question 21

Reference # 806

Answer 21

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