Midazolam

Midazolam drug

1. DRUG PRESENTATION ON
MIDAZOLAM
Submitted To:
Mrs. Deepa Mam
Associate Professor ,
Medical Surgical Nursing Department,
SRIPMS –CON ,
Coimbatore.
Submitted by :
Archana.V ,
B.Sc Nursing 3
rd
year ,
SRIPMS –CON ,
Coimbatore.

2. MIDAZOLAM
INTRODUCTION:
 Midazolam is a Benzodiazepinethat is
used to sedate a person who is undergone a
minor surgery, dental work, or other medical
procedure.
Midazolam is Water soluble
Benzodiazepine with an imidazole ring in its
structure that accounts for stability in
aqueous solutions.

3. Cont...
Midazolam has an affinity for the
benzodiazepine receptor that is
approximately twice that of Diazepam.
Compared with other Benzodiazepines the
amnesic effects of midazolam are more
potent that is sedative effects.

4. Cont...

5. Doses:
Intravenous0.02 –0.03 mg/kg
slowly over 2minutes.
Intramuscular0.07 –0.08mg/kg.
Oral 0.2 –0.5 mg/kg.
Nasal 0.2 –0.3 mg/kg.
Rectal 0.3 mg/kg.

6. Route:
Midazolam can be delivered in three ways.
They are :-
Buccal : Placed on the inside of the cheek.
Intranasal : Sprayed or dripped into the nose.
Intravenous& : Injected into vein or muscle.
Intramuscular

7. Mechanism of action:
Midazolam is a short acting benzodiazepine act
on central nervous system (CNS) depressant.
Benzodiazepines presumably exert their effect
by binding at stereo specific receptors at several
sites within the central nervous system.
All benzodiazepine cause a dose related CNS
depressant activity.

8. Cont...
Midazolam
Bind to GABA-A receptor at different allosteric
sites
Facilitate GABA action
Midazolam increase duration and increase
frequency of opening of Clchannel

9. Cont...
Membrane hyper polarization
CNS Depression

10. Clinical Pharmacology:
Midazolam is a short acting Benzodiazepine
The effect of midazolam on the CNS are
dependent on the dose administered, the
route of administration and the presence or
absence of other medications.
Onset time of sedative effects after IM
administration peak sedation occurring30-
60minutes.

11. Cont...
Sedation in adult and pediatric patients is
achieved within 3-5minutesafter IV injection.
When midazolam is given IV as an anesthetic
induction agent, induction of anesthetic occurs
in approximately 1.5minuteswhen narcotic
premedication has been administered and in 2-
2.5minuteswithout narcotic premedication.

12. Cont...
Midazolam used as directed, does not delay
awakening from general anesthesia in adults.

13. Pharmacokinetics:
Midazolam’s activity is primarily due to the
parent drug.
Midazolam undergoes rapid absorption from
gastrointestinal tract and prompt passage across
the Blood-brain barrier.
Only about 50% of an orally administered dose
of midazolam reaches the systemic circulation,
reflecting a substantial first pass hepatic effect.

14. Cont...
Extensively bound to plasma protein.
Elimination half time Midazolam is 1-4
hours.
Short duration of action of single dose of
midazolam is due to its lipid solubility,
leading to rapid redistribution from the brain
to inactive tissue sites as well as rapid hepatic
clearance.

15. Distribution:
The volume of distribution determined from
six single dose pharmacokinetics studies
involving healthy adult ranged from 3.1l/kg.
In humans, midazolam has been shown to
cross the placenta and enter into fetal
circulation has been detected in human milk
and CSF.

16. Metabolism:
In vitro studies with human liver microsomes
indicate the biotransformation of Midazolam
is mediated by Cytochrome P450-34A.
This cytochrome also appears to be present in
gastrointestinal tract mucosa as well as liver.

17. Excretion:
Clearance of midazolam is reduced in
association with old age, congestive heart
failure, liver disease or condition which
diminish cardiac output and hepatic blood
flow.

18. Indication and Usage :
Pre-operative medication :
-Most commonly used oral pre-
operative.
-Midazolam 0.5mg/kg
administered orally 30minutes before
reliable sedation and anxiolysis in children
without producing delayed awakening.

19. Cont...
Intravenous sedation :
Midazolam in doses of 1.0-2.5mg IV
onset within 30to 60seconds is effective for
sedation during regional anesthesia as well as for
brief therapeutic procedures.
Induction of anesthesia :
Anesthesia can be induced by
administration of midazolam 0.1to 0.2mg/kg
over 30to 60seconds.

20. Cont...
Radiological procedures,
Endoscopy,
Status epileptics.

21. Contra-Indications:
Hypersensitivityto midazolam or any
components of the formulation, including Benzyl
alcohol ( cross sensitivity with other
benzodiazepines).
Parenteral form is not for intrathecal or epidural
injection.
Narrow angel Glaucoma
Use caution in Pregnancy, COPD, CRF, CHF &
elderly.

22. Adverse effect:
Retrograde amnesia,
Headache,
Euphoria,
Drowsiness,
Vomiting,
Coughing,
Laryngospasm,
Excess sedation,
Confusion ,
Hypotension ,
nausea.

23. Drug Interaction :
Drug that inhibit the metabolism of
Midazolam : -Cimetidine
-Ranitidine
-Omeprazole
-Macrolide antibiotics
-Oral contraceptives
Drug that enhance the metabolism of
Midazolam : -Rifampin.

24. Nursing Consideration :
The dose must be individualized based on age,
underlying disease and desired effect.
Deep IM should be given in large muscle mass.
Resuscitate equipment should be at hand before
giving intravenous midazolam.
Monitor respiratory rate continuously during
parental administration for respiratory
depression apnea.
Monitor cardiac function continuously.

25. Conclusion:
Midazolamis a hypnotic-sedative drug with
anxiolytic and marked amnestic properties.
To date it has been used mostly by the
intravenous route, for sedation in dentistry
and endoscopic procedures and as an adjunct
to local anaesthetic techniques.

26. BY:
Archana.V ,
B.Sc Nursing 3
rd
year ,
SRIPMS –CON ,
Coimbatore.