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Drug Study

Drug Study

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Published by Kate Chavez
MIDAZOLAM

FENTANYL \

Prednisolone
MIDAZOLAM

FENTANYL \

Prednisolone

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Published by: Kate Chavez on Mar 02, 2012
Copyright:Attribution Non-commercial

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05/23/2014

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San Beda CollegeCOLLEGE OF NURSING
P.O. BOX 4457 1005 MANILA, PHILIPPINES TELEFAX: 735-6011 to 15 Loc. 4131GENERIC NAME:MIDAZOLAM BRAND NAME: VersedRoute of Administration: IV Dosage: 1mg/IV
DRUGCLASSMODE OFACTIONINDICATIONS/CONTRAINDICATIONSADVERSEREACTIONS TOWATCH OUTFORDRUGINTERACTIONSNURSINGCONSIDERATIONSHEALTHTEACHINGS
Anxiolytics /Hypnotics&Sedatives/ AnticonvulsantsMidazolam is ashort-actingbenzodiazepine. Itexerts sedativeand hypnotic,muscle relaxant,anxiolytic andanticonvulsantactions. While theprobable anxiolyticaction might be asa result of thedrug's ability toincrease glycineinhibitoryneurotransmitterlevel, thehypnotic/anaesthetic action may bedue to theoccupation of thebenzodiazepineand GABAreceptors leadingINDICATION:
 
HIV protease inhibitors,nefazodone,sertraline,gra pefruit juice,fluoxetine,er ythromycin,diltiazem,clarithromycin  inhibit themetabolism omidazolam, leadingto a prolongedaction.St John's wort,rifapentine,ri fampin,rifabutin,p henytoinenhancethe metabolism of midazolam leadingto a reducedaction. Sedatingantidepressants,antiepileptic drugssuchasphenobarbital,Physical andpsychologicaldependencewith withdrawalsymptoms;decreased tidalvolume andrespiration rate;apnoea;headache;hiccup; nausea,increasedappetite,vomiting; cough;oversedation;seizure-likeactivity(paediatrics);paradoxicalreactions;kernicterus;nystagmus; skinrash, pruritus;reducedIncreased CNSdepressionwithalcohol,opioids,barbiturates,other sedativesandanaesthetics.Increasedrespiratorydepressionwithopiates,phenobarbital, otherbenzodiazepines. Plasmaconcentrationsincreased byCYP3A4inhibitors suchascimetidine,erythromycin,clarithromycin,diltiazem,vera• Assess levelof sedationand level of consciousnessthroughoutand for 2-6 hrfollowingadministration.• Monitor BP,pulse andrespirationcontinuouslyduring IVadministration. Oxygen andresuscitativeequipmentshould beimmediatelyavailable.• If overdoseDo not drive orengage inpotentiallyhazardousactivities untilresponse todrug is known. You may feeldrowsy, weak,or tired for 1–2d after drughas beengiven.Be prepared foramnesia toprevent anupsettingpostoperativeperiod.Review writteninstructions toassure future
 
to membranehyperpolarisationand neuronalinhibition, andfurther interferingwith the re-uptakeof GABA at thesynapses.
Absorption:
Rapidly absorbed (anyroute); peakplasmaconcentrationsafter 20-60 min(depending onroute).
Distribution:
Crosses the placenta;enters breast milk.Protein-binding:96%
Metabolism:
Extensively hepatic viaCYP3A4 isoenzyme;converted tohydroxymethylmidazolam.
Excretion:
Urine(as glucuronideconjugates); 2 hr(elimination half-phenytoinandcarbamazepine,sedativeantihistamines,opiates,anti psychoticsandalcoholenhance thesedative effects of midazolam. Midazolam is metabolizedalmost completelybycytochromeP450-3A4.Atorvastatinadministrationalong withmidazolam resultsin a reducedelimination rate of midazolam. St John's wortdecreases theblood levels omidazolam. Grapef ruit juice reducesintestinal 3A4 andresults in lessmetabolism andhigher plasmaconcentrationsCONTRAINDICATION:Acute narrow-angleglaucoma; coma orpatients in shock;alertness,confusion,euphoria,hallucinations,fatigue,dizziness,ataxia, post-operativesedation,anterogradeamnesia; jaundice;cardiac arrest,heart ratechanges,thrombosis;anaphylaxis;laryngospasm,bronchospasm.
PotentiallyFatal:
Respiratory depression,respiratoryarrest;hypotension.pamil,ketoconazoleanditraconazole,antiretroviralagents,quinupristinwithdalfopristin.Midazolamconcentrationdecreasedbyphenytoin,c arbamazepine,phenobarbital,rifampicin.Halothane,thiopentalrequirementsmay bereduced duringconcurrentuse.occurs,monitor pulse,respiration ,and BPcontinuously.Maintainpatent airwayand assistventilation asneeded. If hypotensionoccurs,treatmentincludes IVfluids,repositioningandvasopressors.• The effectsof midazolamcan bereversed withflumazenil(Romazicon).understandingandcompliance.Patientteachingduringamnesticperiod may notberemembered.Even if dose issmall anddepth oamnesia isunclear,relearninformation.
 
life), prolonged inneonates, elderlyand hepaticimpairment.acute alcoholintoxication;intrathecal andepidural admin.Acute pulmonaryinsufficiency ormarkedneuromuscularrespiratoryweakness includingunstablemyasthenia gravis;severe respiratorydepression.
CHAVEZ, KATELENE B.4DCNGROUP 106: 00 am–2:00 pmSan Beda CollegeCOLLEGE OF NURSING
P.O. BOX 4457 1005 MANILA, PHILIPPINES TELEFAX: 735-6011 to 15 Loc. 4131

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