Benzodiazepines Flashcards
Diazepam (Valium)
Class
Benzodiazepine
Sedative-Hypnotic
Anticonvulsant
•Mechanism of Action
Increases the effectiveness of GABA
Raises seizure threshold
Induces amnesia & sedation
Inhibits episodic memory
Diazepam (Valium)
•Indications
Acute anxiety states
Acute alcohol withdrawal
Muscle relaxant
Seizure activity
Agitation
Analgesia for medical procedures
(fracture reduction, cardioversion)
Delirium tremens
Anticholinergic overdose (ie. Cocaine)
Diazepam (Valium)
•Contraindications
Hypersensitivity
Glaucoma
Coma
Shock
Head injury
Diazepam (Valium)
•Adverse Reactions
Respiratory depression
Hypotension
Drowsiness
Ataxia
Reflex tachycardia
Nausea
Confusion
Thrombosis
Phlebitis
Diazepam (Valium)
•Drug Interactions
Incompatible with most drugs, fluids.
•How Supplied
10 mg/5 ml prefilled syringes, ampules, vials &Tubex.
Diazepam (Valium)
•Dosage and Administration
Seizure activity: Adult:
5-10 mg IV/IO/IM/PR
Seizure activity: Pediatric:
0.2-0.3 mg/kg/dose IV every 15-30 minutes (no faster than 3 mg over 5 minutes) (max. = 10 mg/kg).
Rectal diazepam: 0.5 mg/kg via 2” rectal catheter and flush with 2-3 ml air after administration.
Sedation for cardioversion: 2.5-5 mg IV/IO/IM/IN/PR
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Diazepam (Valium)
•Duration of Action
Onset: 1-5 minutes
Peak effect: minutes
Duration: 20-50 minutes
•Special Considerations
Pregnancy safety: Category D
Short duration of anticonvulsant effect
Reduce dose 50% in elderly patient
Lorazepam (Ativan)
Class
Benzodiazepine
Sedative
Anticonvulsant
•Mechanism of Action
Anticonvulsant and sedative effects, Increases GABA effectiveness
Suppresses propagation of seizure activity produced by
foci in cortex, thalamus and limbic areas
Inhibits episodic memory and
repetition priming memory (increased response to a repetitive
stimulus)
Lorazepam (Ativan)
•Indications
Initial control of status epilepticus or severe recurrent
seizures
Severe anxiety Sedation
Lorazepam (Ativan)
•Contraindications
Coma
Shock
Suspected drug abuse
•Adverse Reactions
Respiratory depression
Apnea
Drowsiness
Sedation
Ataxia
Psychomotor impairment
Confusion
Restlessness
Delirium
Hypotension
Bradycardia
Lorazepam (Ativan)
•Drug Interactions
May precipitate CNS depression if patient is already
taking CNS depressant medications
•How Supplied
2 and 4 mg / ml concentrations in 1 ml vials
Lorazepam (Ativan)
•Dosage and Administration
Note: When given IV or IO, must dilute with equal
volume of sterile water or sterile saline;
When given IM, Lorazepam is not to be
diluted
Adult: 2-4 mg slow IV/IO at 2 mg/min. or IM; may
repeat in 15-20 minutes to maximum dose of
8 mg. For sedation: 0.05 mg/kg up to 4 mg
IM
Pediatric: 0.05 - 0.20 mg/kg slow IV, IO slowly over
2 minutes or IM; may repeat in 15-20
minutes to maximum dose of 0.2 mg/kg
RI OEMS Protocols
•2.07 Adult Comfort
An advanced airway must be in place
1-2 mg IVP q 15 min with max 10mg
May be used with Fentanyl
•2.19 Adult Seizure
4mg IV with repeat of 2mg every 3-5 min to a max of 10mg
May be used refractory to Midazolam
RI OEMS Protocols
•2.19 Pediatric Seizure
.1 mg/kg IV (4mg Max single dose) with repeat in 5min to a max of .5mg/kg
Midazolam (Versed)
Class
Short-acting benzodiazepine CNS depressant
•Mechanism of Action
Anxiolytic (inhibits anxiety) and sedative properties similar to
other benzodiazepines
Memory impairment
•Indications
Sedation
Anxiolytic prior to endotracheal/nasotracheal intubation
Administer for conscious sedation
Midazolam (Versed)
•Contraindications
Glaucoma
Shock
Coma
Alcohol intoxication
Overdose patient
Depressed vital signs
Concomitant use with other CNS depressants,
barbiturates, alcohol, narcotics
Midazolam (Versed)
•Adverse Reactions
Hiccough
Cough
Over-sedation
Nausea
Vomiting
Injection site pain
Headache
Blurred vision
Hypotension
Respiratory depression and arrest
Midazolam (Versed)
•Drug Interactions
Should not be used in patients who have taken CNS
depressant
•How Supplied
2, 5, 10 ml vials (1 mg / ml )
1, 2 , 5, 10 ml vials (5 mg/ ml )
Midazolam (Versed)
•Dosage and Administration
Adult: 0.5 - 2.5 mg slow IV push;
(may be repeated to total maximum: 0.1 mg / kg).
Pediatric: To facilitate intubation: Medical control
may order:
(6 months- 5 years) Use of Midazolam (Versed)
0.05-0.1 mg/kg IV maximum dose of 5 mg.
(6-12 year old) Use of Midazolam (Versed) 0.1
mg/kg IV maximum dose of 8 mg.
Midazolam (Versed)
•Duration of Action
Onset: 1-3 minutes IV and dose dependent.
Peak effect: variable.
Duration: 2-6 hours and dose dependent.
•Special Considerations
Pregnancy safety: category D.
Administer immediately prior to intubation procedure.
Requires continuous monitoring of respiratory and
cardiac function.
RI OEMS Protocols
•2.07 Adult Comfort
2.5-5mg IV/IM/IN for sedation for cardioversion
2.5-5mg IV q 5-10 min as needed to maintain intubated patient
•2.07 Pediatric Comfort
.1mg/kg (2.5mg Max) IV/IM/IN for sedation for cardioversion
•2.09 Behavioral Emergencies
2.5-5mg IV or 5mg IM/IN repeat PRN if systolic BP > 100mmHg
Cumulative dose of 10 mg
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RI OEMS Protocols
•2.19 Adult Seizures
2.5mg IV (5mg IM or 2mg IN) repeat every 3-5 min to a max of 20 mg
•2.19 Pediatric Seizures
.2 mg/kg IM/IN or .1 mg/kg IV (4mg maximum single dose any route). Repeat q 5 min to a max of 1 mg/kg
RI OEMS Protocols
•2.25 Excited Delirium
2.5-5mg IV or 5mg IM/IN repeat PRN if systolic BP > 100mmHg
•3.01 Acute Decompensated Heart Failure
1-2mg IV to enhance CPAP compliance
•3.06 Narrow Complex Tachycardia
2.5-5mg IV or 5mg IM/IN for sedation prior to cardioversion
Pediatric .1 mg/kg (2.5mg max) IV/IM/IN with repeat x1
Contraindicated if less than 5kg
RI OEMS Protocols
•3.07 Wide Complex Tachycardia
2.5-5mg IV or 5mg IM/IN for sedation prior to cardioversion
Pediatric .1 mg/kg (2.5mg max) IV/IM/IN with repeat x1
Contraindicated if less than 5kg
•4.17 Bites Stings
For severe muscle spasms: .5-2mg IV, 1-2mg IN, 5mg IM
Pediatric: .1-.2mg/kg IV, .2mg/kg IN
RI OEMS Protocols
•4.18 Toxicological Emergencies
2.5 mg IV/IN [5 mg IM], may repeat in 5 minutes [IM dose in 20 minutes]
Pediatric: 0.05 mg/kg IV/IN (may repeat X1 in 10 min) [do not
Thiamine
Class
Vitamin (B1)
•Mechanism of Action
Combines with ATP to form thiamine
pyrophosphate coenzyme, a necessary
component for carbohydrate metabolism
The brain is extremely sensitive to thiamine
deficiency
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Thiamine
•Indications
Delirium tremens
Beriberi (Thiamine deficiency)
Wernicke’s encephalopathy
•Contraindications
None
Thiamine
•Adverse Reactions
Hypotension from too rapid injection or too high a dose.
Anxiety
Diaphoresis
Nausea
Vomiting
Rare allergic reaction
•Drug Interactions
Give thiamine before glucose under all circumstances.
Thiamine
•How Supplied
1,000 mg in 10 ml vial (100 mg / ml)
•Dosage and Administration
Adult: 100 mg slow IV or IM
Pediatric: 10-25 mg slow IV or IM
Thiamine
•Duration of Action
Onset: Rapid
Peak effects: variable
Duration: Dependent upon degree of deficiency
•Special Considerations
Pregnancy safety: Category A
Large IV doses may cause respiratory difficulties
Anaphylaxis reactions reported
RI OEMS Protocols
