MIDAZOLAM

A Drug Study presented to

The Faculty of Nursing Department
Ms. Nympha Fernando, RN, MN

In Partial Fulfilment of
The Requirements in NCM 219 – RLE
INTENSIVE CARE UNIT NURSING ROTATION

By
Riza Joy Lacierda, St.N
BSN 4M – GROUP 3

October 23, 2022

Generic Name: Midazolam

Brand Name: Versed

Classification: Pharmacologic class: Benzodiazepine
Therapeutic class: Anxiolytics
Mode of Action: May exert sedating effect by increasing activity of
gamma-aminobutyric acid, a major inhibitory
neurotransmitter in the brain. As a result, midazolam
produces a calming effect, relaxes skeletal muscles,
and—at high doses—induces sleep.
Suggested Dose and I.V. Injection;
Route: Adults under age 60 and adolescents - Initial: Up to 2.5
mg over 2 minutes immediately before procedure. After
2 minute waiting period, dosage adjusted to desired
level in 25% increments, as ordered. Maximum: 5 mg.
Indication: To induce preoperative sedation or amnesia, to control
preoperative anxiety
Contraindication: Acute angle-closure glaucoma; acute pulmonary
insufficiency; debilitated or elderly patients outside the
ICU setting; hypersensitivity to midazolam, other
benzodiazepines, or their components; severe chronic
obstructive pulmonary disease
Side Effects: Nausea, vomiting, dizziness, drowsiness, headache
Adverse Effects: CNS: Agitation, delirium, or dreaming during emergence
from anesthesia; anxiety; ataxia; chills; combativeness;
 confusion; euphoria; excessive sedation; insomnia;
lethargy; nervousness; nightmares; paresthesia;
prolonged emergence from anesthesia; restlessness;
retrograde amnesia; sleep disturbance; slurred speech;
suicidal ideation (nasal spray form); weakness; yawning
CV: Cardiac arrest, hypotension, nodal rhythm, PVCs,
tachycardia, vasovagal episodes
EENT: Blurred vision, diplopia, or other vision changes;
increased salivation; laryngospasm; miosis; nystagmus;
toothache
GI: Hiccups, retching
RESP: Airway obstruction, bradypnea, bronchospasm,
coughing, decreased tidal volume, dyspnea,
hyperventilation, respiratory arrest, shallow breathing,
tachypnea, wheezing
SKIN: Pruritus, rash, urticaria
Other: Injection-site burning, edema, induration, pain,
redness, and tenderness
Drug Interaction: Drugs-Drug
 cimetidine, diltiazem, erythromycin, fluconazole,
itraconazole, ketoconazole, ritonavir, saquinavir,
verapamil: Intense and prolonged sedation caused
by reduced midazolam metabolism
 CNS depressants (secobarbital), droperidol-fentanyl
combination, opioids (fentanyl, meperidine,
morphine): Possibly increased CNS and respiratory
depression and hypotension
 halothane: Reduced minimum alveolar concentation
of halothane required during maintenance of
anesthesia
 pancuronium: Potentiated effect of pancuronium
  sodium valproate: Increased effect of midazolam
 thiopental: Slight reduction in dosage reguirement of
thiopental following I.M. midazolam

Drug-Food:
 grapefruit products: increase the amount of certain
medication in the bloodstream

Drug-Lifestyle
 Alcohol use: may cause additive CNS effects
Nursing Responsibilities:
1. Ask the patient if he/she is allergic to Sodium
Bicarbonate or any of its components
R: to avoid any allergic reactions that can worsen
the health of the patient.
2. Determine if the patient is taking antibiotics or
antihypertensive drugs
R: to prevent intense and prolonged sedative
effect.
3. Assess the level of consciousness frequently
R: to monitor the range between sedation and
unconsciousness or disorientation.
4. Monitor the side effects of the drug
R: to know if the patient is having the common
side effects or other serious side effects.
5. Educate the patient not to take grapefruit
products
R: to prevent accumulation of certain medication
in the bloodstream.
6. Instruct the patient to stay in bed while taking the
drug
R: to prevent fall.
 7. Inform the patient that he may not remember the
procedure or any events
R: to inform the patient about the effects of the
drug which is amnesia.
8. Provide written information and family member
instruction about the procedure/surgery
R: to enable the patient from recalling the events.
9. Monitor if the patient is experiencing pain,
stinging or burning sensation and edema
R: to prevent extravasations.
10. Monitor vital signs
R: to observe any signs of respiratory depression
and sedation.

Reference
Ambrose, P. (2021). 2021 Nurse’s Drug Handbook. Jones & Bartlett Learning. pp 1761-
1766.
Starship (2021). Midazolam. Retrieved on October 18, 2022 from
https://starship.org.nz/guidelines/midazolam/
Woods, D. (2021). Nursing 2021: Drug Handbook. Wolters Kluwer. pp. 1833-1838.