Name /bks 53161 deglins md disk/midazolam 02/17/2014 07: 44am plate # 0-Composite
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Name /bks_53161_deglins_md_disk/midazolam 02/17/2014 07:44AM Plate # 0-Composite pg 1 # 1 PDF Page #1 ϭ Canadian drug name. ϭ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ϭ Discontinued. 1 High Alert midazolam (mid-ay-zoe-lam) Versed
tive sedation/anxiolysis/amnesia. IV: Provides sedation/anxiolysis/amnesia during therapeutic, diagnostic, or radiographic procedures (conscious sedation): Aids in the induction of anesthesia and as part of balanced anesthesia, As a continuous infu- sion, provides sedation of mechanically ventilated patients during anesthesia or in a critical care setting, Status epilepticus. Action Acts at many levels of the CNS to produce generalized CNS depression. Effects may be mediated by GABA, an inhibitory neurotransmitter.
Short-
term sedation. Postoperative amnesia. Pharmacokinetics Absorption: Rapidly absorbed following oral and nasal administration; undergoes substantial intestinal and first-pass hepatic metabolism. Well absorbed following IM administration; IV administration results in complete bioavailability. Distribution: Crosses the blood-brain barrier and placenta; excreted in breast milk.
97%.
Metabolism and Excretion: Almost exclusively metabolized by the liver, result- ing in conversion to hydroxymidazolam, an active metabolite, and 2 other inactive metabolites (metabolized by cytochrome P450 3A4 enzyme system); metabolites are excreted in urine.
Preterm neonates: 2.6– 17.7 hr; Neonates: 4– 12 hr; Children: 3– 7 hr; Adults: 2– 6 hr (increased in renal impairment, HF, or cirrhosis). TIME/ACTION PROFILE (sedation) ROUTE ONSET PEAK DURATION IN 5 min 10 min 30–60 min IM 15 min
30–60 min 2–6 hr
IV 1.5–5 min rapid 2–6 hr
Contraindications/Precautions Contraindicated in: Hypersensitivity; Cross-sensitivity with other benzodiaze- pines may occur; Shock; Comatose patients or those with pre-existing CNS depres- sion; Uncontrolled severe pain; Acute angle-closure glaucoma; OB: Benzodiazepine drugs mayqrisk of congenital malformations; use in the last weeks of pregnancy has caused CNS depression in the neonate; Lactation: Lactation; Pedi: Products con- taining benzyl alcohol should not be used in neonates.
Pulmonary disease; HF; Renal impairment; Severe hepatic im- pairment; Obese pediatric patients (calculate dose on the basis of ideal body weight);
Rapid injection in neonates has caused severe hypotension and seizures, espe- cially when used with fentanyl; Geri: Older patients (especially Ͼ 70 yr) are more susceptible to cardiorespiratory depressant effects; dosageprequired. Adverse Reactions/Side Effects CNS: agitation, drowsiness, excess sedation, headache. EENT: blurred vision. Resp: APNEA
, LARYNGOSPASM , RESPIRATORY DEPRESSION , bronchospasm, coughing. CV: CARDIAC ARREST , arrhythmias.
hiccups, nausea, vomiting. Derm: rashes.
Local: phlebitis at IV site, pain at IM site. Interactions Drug-Drug: q CNS depression with alcohol, antihistamines, opioid analge- sics, and other sedative/hypnotics (pmidazolam dose by 30– 50% if used concur- rently).qrisk of hypotension with antihypertensives, opioid analgesics, acute ingestion of alcohol, or nitrates. Midazolam is metabolized by the cytochrome P450 3A4 enzyme system; drugs that induce or inhibit this system may be expected to alter the effects of midazolam. Carbamazepine, phenytoin, rifampin, rifabutin, and phenobarbitalplevels. Erythromycin, cimetidine, ranitidine, diltiazem, verapamil, fluconazole, itraconazole, and ketoconazolepmetabolism and mayqrisk of toxicity. Name /bks_53161_deglins_md_disk/midazolam 02/17/2014 07:44AM Plate # 0-Composite pg 2 # 2 ᭧ 2015 F.A. Davis Company
PDF Page #2 2 Drug-Natural Products: Concomitant use of kava-kava, valerian, or chamo- mile canqCNS depression. Long term use of St. John’s wort may significantlyplev- els.
Drug-Food: Grapefruit juicepmetabolism and mayqrisk of toxicity. Route/Dosage Dose must be individualized, taking caution to reduce dose in geriatric patients and in those who are already sedated.
should not exceed 20 mg); patients with cardiac/respiratory compromise or con- current CNS depressants— 0.25 mg/kg. IM (Adults Otherwise Healthy and Ͻ
gery (usual dose 5 mg).
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fore surgery (usual dose 1– 3 mg).
not to exceed 10 mg/dose. Conscious Sedation for Short Procedures IV (Adults and Children Otherwise Healthy Ͼ
Ͻ
initially; dosage may beqfurther as needed. Total doses Ͼ 5 m g are rarely needed (p dose by 50% if other CNS depressants are used). Maintenance doses of 25% of the dose required for initial sedation may be given as necessary. IV (Children 6– 12 yr): 0.025– 0.05 mg/kg initially, then titrate dose carefully, may need up to 0.4 mg/kg total, maximum dose 10 mg. IV (Children 6 mo– 5 yr): 0.05 mg/kg initially, then titrate dose carefully, may need up to 0.6 mg/kg total, maximum dose 6 mg. IV (Geriatric Patients Ն
tially; dose may beqfurther as needed. Total doses Ͼ 3.5 m g are rarely needed (p dose by 30% if other CNS depressants are used). Maintenance doses of 25% of the dose required for initial sedation may be given as necessary. Intranasal (Children): 0.2– 0.3 mg/kg, may repeat in 5– 15 min. Status Epilepticus IV (Children Ͼ
kg/min. Titrate dose upward q 5 min until seizure controlled, range: 1– 18 mcg/kg/ min.
Induction of Anesthesia (Adjunct) May give additional dose of 25% of initial dose if needed. IV (Adults Otherwise Healthy and Ͻ
mcg/kg total). If patient is premedicated, initial dose should be furtherp.
Ͼ
medicated, initial dose should be furtherp.
cated, initial dose should be furtherp. Sedation in Critical Care Settings IV (Adults): 0.01– 0.05 mg/kg (0.5– 4 mg in most adults) initially if a loading dose is required; may repeat q 10– 15 min until desired effect is obtained; may be followed by infusion at 0.02– 0.1 mg/kg/hr (1– 7 mg/hr in most adults).
dose; follow with infusion at 0.06– 0.12 mg/kg/hr (1– 2 mcg/kg/min), titrate to ef- fect, range: 0.4– 6 mcg/kg/min.
Ͼ
min).
Ͻ
min).
● Assess level of sedation and level of consciousness throughout and for 2–6 hr fol- lowing administration. ● Monitor BP, pulse, and respiration continuously during IV administra- tion. Oxygen and resuscitative equipment should be immediately avail- able. ● Toxicity and Overdose: If overdose occurs, monitor pulse, respiration,and BP continuously. Maintain patent airway and assist ventilation as needed. If hypoten- sion occurs, treatment includes IV fluids, repositioning, and vasopressors. ● The effects of midazolam can be reversed with flumazenil (Romazicon).
Name /bks_53161_deglins_md_disk/midazolam 02/17/2014 07:44AM Plate # 0-Composite pg 3 # 3 ϭ Canadian drug name. ϭ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ϭ Discontinued. 3 CONTINUED midazolam PDF Page #3 Potential Nursing Diagnoses Ineffective breathing pattern (Adverse Reactions) Risk for injury (Side Effects)
● High Alert: Accidental overdose of oral midazolam syrup in children has re- sulted in serious harm or death. Do not accept orders prescribed by volume (5 mL or 1 tsp); instead, request dose be expressed in milligrams. Have second practi- tioner independently check original order and dose calculations. Midazolam syrup should only be administered by health care professionals authorized to ad- minister conscious sedation. ● PO: To use the Press-in Bottle Adaptor (PIBA), remove the cap and push bottle adaptor into neck of bottle. Close bottle tightly with cap. Solution is a clear red to purplish-red cherry-flavored syrup. Then remove cap and insert tip of oral dis- penser in bottle adaptor. Push the plunger completely down toward tip of oral dis- penser and insert firmly into bottle adaptor. Turn entire unit (bottle and oral dis- penser) upside down. Pull plunger out slowly until desired amount of medication is withdrawn into oral dispenser. Turn entire unit right side up and slowly remove oral dispenser from the bottle. Tip of dispenser may be covered with tip of cap un- til time of use. Close bottle with cap after each use. ● Dispense directly into mouth. Do not mix with any liquid prior to dispensing. ● Intranasal: Administer using a 1 mL needleless syringe into the nares over 15 sec. Using the 5 mg/mL injection, administer half dose into each nare. ● IM: Administer IM doses deep into muscle mass, maximum concentration 1 mg/ mL.
● pH: 2.9–3.7. ● Direct IV: Diluent: Administer undiluted or diluted with D5W or 0.9% NaCl.
Undiluted: 1 mg/mL or 5 mg/mL. Diluted: 0.03– 3 mg/mL. Rate: Administer slowly over at least 2– 5 min. Titrate dose to patient response. Rapid injection, especially in neonates, has caused severe hypotension. ● Continuous Infusion: Diluent: Dilute with 0.9% NaCl or D5W. Concentra- tion: 0.5– 1 mg/mL. Rate: Based on patient’s weight (see Route/Dosage sec- tion). Titrate to desired level of sedation. Assess sedation at regular intervals and adjust rate up or down by 25– 50% as needed. Dose should also be decreased by 10– 25% every few hours to find minimum effective infusion rate, which prevents accumulation of midazolam and provides more rapid recovery upon termination. ● Y-Site Compatibility: alemtuzumab, alfentanil, amikacin, amiodarone, anidu- lafungin, argatroban, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, buprenorphine, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefazolin, cefotaxime, cefoxitin, ceftaroline, ceftriax- one, ciprofloxacin, cisatracurium, cisplatin, cyanocobalamin, cyclophospha- mide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexmedetomidine, di- goxin, diltiazem, diphenhydramine, docetaxel, dopamine, doripenem, doxacurium, doxarubicin hydrochloride, doxycycline, enalaprilat, epinephrine, epirubicin, eptifibatide, erythromycin lactobionate, esmolol, etomidate, etopo- side, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludar- abine, folic acid, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hydromorphone, idarubicin, ifosfamide, irinotecan, isoproterenol, labetalol, lev- ofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mech- lorethamine, meperidine, metaraminol, methadone, methoxamine, methyldo- pate, metoclopramide, metoprolol, metronidazole, milrinone, mitoxantrone, morphine, multivitamins, mycophenolate, nalbuphine, naloxone, nesiritide, ni- cardipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuro- nium, papaverine, pemetrexed, penicillin G potassium, pentamidine, pentazocine, phentolamine, phenylephrine, phytonadione, potassium chloride, procainamide, promethazine, propranolol, protamine, pyridoxime, quinupristin/dalfopristin, ranitidine, remifentanil, rifampin, rocuronium, streptokinase, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiotepa, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, vancomycin, vasopressin, vecuronium, ver- apamil, vincristine, vinorelbine, voriconazole, zoledronic acid. ● Y-Site Incompatibility: acyclovir, aminocaproic acid, aminophylline, ampho- tericin B cholesteryl, amphotericin B colloidal, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin/sulbactam, ascorbic acid, aza- thioprine, cefepime, ceftazidime, cefuroxime, chloramphenicol, dantrolene, dex- amethasone sodium phosphate, diazepam, diazoxide, epoetin alfa, ertapenem, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, indomethacin, ke-
Name /bks_53161_deglins_md_disk/midazolam 02/17/2014 07:44AM Plate # 0-Composite pg 4 # 4 ᭧ 2015 F.A. Davis Company PDF Page #4 4 torolac, methotrexate, micafungin, omeprazole, pantoprazole, pentobarbital, phenobarbital, phenytoin, piperacillin/tazobactam, potassium acetate, prochlor- perazine, sodium bicarbonate, thiopental, trimethoprim/sulfamethoxazole. Patient/Family Teaching ● Inform patient that this medication will decrease mental recall of the procedure. ● May cause drowsiness or dizziness. Advise patient to request assistance prior to ambulation and transfer and to avoid driving or other activities requiring alertness for 24 hr following administration. ● Instruct patient to inform health care professional prior to administration if preg- nancy is suspected. ● Advise patient to avoid alcohol or other CNS depressants for 24 hr following ad- ministration of midazolam.
● Sedation during and amnesia following surgical, diagnostic, and radiologic proce- dures. ● Sedation and amnesia for mechanically ventilated patients in a critical care setting. Why was this drug prescribed for your patient? Yüklə 52,47 Kb. Dostları ilə paylaş:
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