All right, you guys. Welcome back to another
video lesson from ICU Advantage. My name is Eddie Watson and my goal is to give you guys
the confidence to succeed in the ICU by making these complex, critical care subjects
easy to underst. I truly hope that I'm able to do just that. And if I am, I do invite
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lesson. All right. Now, real quick, before we get started, I just wanted to
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then, you're gonna save 50% off the launch. So don't miss out on a great deal
and opportunity for a really a lifetime worth of learning and CE
credits for a limited time price. All right, so in this lesson we are
talking about Midazolam also goes by the trade name verse Ed. So just a quick
history and background. This medication was initially synthesized in 1975 by Walser
and Fry at Hoffman LAROCHE Incorporated, and this is actually a Swiss
pharmaceutical company. And this was actually a favorable drug opposed
to some, you know, 35 other ish benzodiazepines that are currently used in healthcare due to its
water solubility and really being less likely to cause thrombophlebitis and then anticonvulsant.
Properties of midazolam were studied in the 1970s, but it really wasn't recognized as an appropriate
treatment for status epilepticus until the 1990s. So Midazolam is a benzodiazepine that's
often used for the induction of anesthesia and to produce conscious sedation for
its therapeutic actions. It's believed that it works by binding GABA receptors
and really potentiating the effects of endogenous gaba, which is a major inhibitory
neurotransmitter in the central nervous. Thus, it depresses the central nervous system.
It also works to suppress the spread of seizure activity as well. Now for our indications, it
promotes perioperative sedation, anxiolysis, anesthesia induction, or amnesia. It's also
used for the treatment of status epilepticus in adults and typically in critical care
setting, we're either using it for procedural sedation or for ongoing continuous sedation
in our intubated and ventilated patients. As for some contraindications,
obviously hypersensitivity to the drug is gonna be. We do want to use
caution in older adults or patients who are debilitated. Those really
with uncompensated acute illness, heart failure, respiratory, renal, or
hepatic disease and those with increased risk of falls. And then benzodiazepines
are associated with paradoxical reactions. So sometimes it can actually lead to agitation,
aggressive behavior as well as involuntary move. now, as for our adverse effects, so again,
system by system for the central nervous system. So one potential effect is gonna
be over sedation. Obviously drowsiness, amnesia, seizures, potentially those involuntary
movements, paradoxical behaviors and excitement. For the cardiovascular system, we can see
variations in our patients' heart rate and blood pressure. Although hypotension
is actually gonna be less common and typically less severe when we're comparing
this to a medication like propofol. Now, for E N T nystagmus is something
that we can see. For GI, nausea and vomiting can potentially come about.
And then for our respiratory system, big ones are gonna be decreased respiratory
rate, decreased oxygen, SATs, and apnea. So as far as our common concentrations go
this medication does come in a PO form in a a syrup. And, and typically you can see that in
a two milligram per ml in like a Hunter ML bottle. Or they do have some single use cups
of 10 milligrams in 5 MLs. So again, another 2 milligram per ML concentration for IV
push. The most common concentration is gonna be a one milligram per ML concentration, so two
milligrams, two mls, five milligrams, and five mls. That said I believe there is some formulation
in which is a five milligram per ML concentration. Now for continuous sedation, typically again,
we're gonna see a 1 mg per ml concentration. Something like 50 mg in 50 MLs, or a 100
mg in 100 MLs. now for our common dosing, I'm gonna primarily focus on the, IV
form of this medication for IV pushes. The dose really depends greatly on
the patient's clinical condition as well as their potential tolerance to
the medication, as well as their size. But a push dose of one to two milligrams
is pretty common. But we certainly can't also give larger doses as. For the IV infusion
again, really kind of depends on the use here, but for sedation we're typically gonna start
out at around two milligrams per hour and then titrate for a rascal. And ideally here
our max is gonna be 10 milligrams per hour. That said, some of you guys are
probably thinking that I'm crazy by saying that cause you've seen it go much
higher. And this is absolutely the case, especially for things like status epilepticus.
If they've got a brain injury and elevated ICPs, if we're doing proning and paralytic therapy,
as well as other things in there as well. So we definitely can see higher doses than the 10
milligrams per hour. now for our pharmacokinetics, again, for our IV administration, onsets
pretty quick, anywhere from 90 seconds to to five minutes. Typically it tends to be on the
lower end of this, more towards 90 seconds. The peak is anywhere from five to seven minutes, and
the duration is typically less than two hours. That said, with cirrhosis, we can see.
This actually go up to six hours. And the reason for this is it is metabolized
primarily in the liver and the gut, and it gets metabolized into four main
metabolites, all of which have various roles in the effect of midazolam. And then
these metabolites do get excreted in the urine. Now, as far as our antidote goes, we do
have an antidote for this called omano, also goes by the name Zicon, and here the dose is
gonna be 0.2 milligrams iv. now for our nursing considerations. Now again, this should only be
administered by someone who's been specifically trained and has the knowledge when using this
medication as a sedative for procedural sedation. So we wanna make sure that the, the
antidote, Ramas Flumazenil should really be readily available in the
event that we do have over sedation, which can lead to impaired respiratory status and
depression. That said, we also wanna make sure we've got rescue equipment nearby. Again,
typically not an issue in the ICU U, but. You know, things like our code cart, bag, valve
mask suctioning can be really important as well if we're, we're dealing with this, make sure that
you are monitoring your patient's blood pressure, heart rate and rhythm, their respirations, their
airway integrity, and then make sure we've got a continuous pulse oxs, especially if we're doing
the conscious sedation or procedural sedation. And then just be aware that individuals
that have underlying hepatic impairments and cirrhosis that they may metabolize
this drug slower leading to a prolonged duration of the drug as opposed to those
who have normal hepatic function. As well as we do also want to be using decreased
dosing in patients who have renal failure. And here, typically we're looking at a 50%
decrease in the dose. And then finally, for any relevant laboratory studies, there actually
aren't any identified with this medication. And that is gonna be our review of Midazolam
aka ved. So I hope that you guys found this information useful. If you did, please
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so much for watching. Have a great day.