Lorazepam

Question 1

Generic Name:

Answer 1

Lorazepam

Question 2

Trade Name:

Answer 2

Ativan

Question 3

Class:

Answer 3

Anticonvulsant, Sedative, Anxiolytic, Benzodiazepine, short or intermediate acting

Question 4

Supplied:

Answer 4

4mg/mL vial

Question 5

Mechanism of Action:

Answer 5

Agent has high affinity for the gamma-amino butyric acid (GABA) benzodiazepine receptor complex without displacing GABA, (GABA is the major inhibitory neurotransmitter in the brain). It exerts tranquilizing action on the central nervous system.

Question 6

Indications and Field Use

Answer 6

• Status epilepticus
• Seizure
• Agitation

Question 7

Contraindications:

Answer 7

• Known sensitivity to the benzodiazepines
• Acute narrow angle glaucoma or myasthenia gravis
• Known hypersensitivity to polyethylene glycol, propylene glycol or beryl alcohol
• Pregnancy (relative)

Question 8

Adverse Reactions:

Answer 8

- Most frequent adverse reaction is sedation
- Transient amnesia or memory impairment
- Confusion
- Hypotension
- Respiratory depression
- Dizziness
- Headache

Question 9

Incompatibilities/Drug Interactions:

Answer 9

Concomitant use of CNS sedatives such as phenothiazines, narcotic analgesics, barbiturates, antidepressants, and alcohol should be assessed prior to administration of IV Lorazepam.

Question 10

Administration:

Answer 10

IM: Should be administered deep into the muscle mass

IV/IO: Do not exceed 2mg/minute or 0.05mg/kg over 2-5 minutes. Dilute IV dose with equal volume of compatible dilutent (D5W, NS, SWI).

Inadvertent intra-arterial injection may produce arteriospasm resulting in necrosis and potential amputation.

Question 11

Adult Dosage: Status epilepticus:

Answer 11

2mg to 5mg IV/IO given slowly (over 2 to 5 minutes) May repeat dose in 10 to 15 minutes if needed (maximum 10mg). May give IM if no IV/IO access.

Question 12

Pediatric Dosage: Status epilepticus:

Answer 12

0.05 - 0.1 mg/kg IV/IO over 2 to 5 minutes (maximum 4 mg). May repeat in 10 to 15 minutes.

Question 13

Routes of Administration:

Answer 13

• IV injection is the route of choice
• IM injections with large bore needle
• IO

Question 14

Onset of Action:

Answer 14

1 to 2 minutes if given IV/IO

Question 15

Peak Effects:

Answer 15

• Less than 15 minutes when given IV/IO

- Within 3 hours given IM

Question 16

Duration of Action:

Answer 16

Approximately 6 to 8 hours

Question 17

Arizona Drug Box Minimum Supply:

Answer 17

8mg

Question 18

Special Notes:

Answer 18

- For age >60 or weight <60 kg: Consideration of lower doses must be made when administering Lorazepam IV to elderly patients, seriously ill patients, and those with limited pulmonary reserve. Apnea and/or cardiac arrest may occur. Patients over the age of 50 years may have a more profound and prolonged sedation with IV Lorazepam.

- All patients should be monitored for respiratory depression and hypotensive effects. Stability above room temperature has not been established.

• Be prepared to ventilate, OD may be reversed with Flumazenil, for IV/IO use, dilute 1:1 in NS.