Benzodiazepines

Question 1

Diazepam

Answer 1

• AKA Valium
• 5 mg/ml
• Benzodiazepine
• Muscle relaxer, anxiolytic, anticonvulsant
• IV administration
• Dogs and cats: 0.1-0.5 mg/kg
• Recommended starting dose: 0.25 mg/kg
• Anticonvulsant dose: 0.5 mg/kg IV
• Reversal agent: Flumazenil 0.01 mg/kg
• Absorbs well rectally- tablets or injectable liquid may be used for seizures if no patent IV access
• Can be used as a CRI is status epilepticus patients- use caution in plastic syringe
• Dissociates in plastic syringes after prolonged period of time
• Adverse effects: use cautiously in healthy, alert patients- may cause paradoxical excitability effect, consider use in combination with opioid/sedative/tranquilizer to avoid this side effect
• Contraindications/ Cautions: DO NOT USE IN PATIENTS WITH HEPATIC SHUNT DISORDERS – causes profound sedation and delayed recovery due to inability to metabolize drug efficiently (reversal less effective in these patients) Cats: due to concerns associated with idiopathic hepatic failure, best to use midazolam. The carrier agent for Diazepam is polypropylene glycol can cause hepatic failure in cats, dissociation of drug in plastic, and may crystallize when mixed with other drugs! DO NOT MIX!

Question 2

Ketamine

Answer 2

• Dissociative induction agent
• 100 mg/ml
• Some analgesic properties
• IV or IM administration
• Dogs and Cats: 2-6 mg/kg for induction, best if combined with co-induction agent
• Recommended starting dose: 2 mg/kg
• Reversal agent: Naloxone 0.04 mg/kg
• Excellent chemical restraint properties- 0.25- 0.5 mg/kg IM (combined w/ Torb and Dexmedetomidine- see above)
• Rescue analgesic at 0.5 mg/kg IV
• Adverse effects: rigidity, dysphoria
• Contraindications: head trauma, heart failure, significant hypertension, and arterial aneurysms, elevated ICPs, patients w/ pre-existing seizure conditions, cats w/ HCM, and cats w/ reduced renal function