Lorazepam/ Ativan

Question 1

Lorazepam Class

Answer 1

• Benzodiazepine
• Anticonvulsant
• Schedule IV Controlled Substance

Question 2

Lorazepam Action

Answer 2

• Decreases CNS acivity
• Decreases Anxiety
• Promotes relaxation and depresses muscle and motor nerve function directly.
• Anticonvulsant /limits the spread of electrical activity.
• Has a shorter elimination half-life than diazepam, but persists in the CNS longer due to “redistribution phenomena”.

Question 3

Lorazepam Indications

Answer 3

• Major motor seizures
• Status epilepticus
• Sedation prior to cardioversion
• Acute anxiety/behavioral emergencies
• Management of alcohol withdrawal symptoms
• Sedation in mechanical ventilation

Question 4

Lorazepam Contraindications

Answer 4

• Shock
• Hypersensitivity
• Closed angle glaucoma

Question 5

Lorazepam Precautions

Answer 5

• Reduce dose for geriatrics
• Hepatic dysfunction
• Renal insufficiency
• History of drug addiction
• Parkinson’s disease
• Pregnancy (D)
• Myasthenia gravis
• Respiratory depression (unless ventilated)
• Current substance abuse (relative)

Question 6

Lorazepam Dosage

Answer 6

Adults:
• Status Epilepticus:
IV/IO: 1-2 mg, may repeat at 10 min, max total dose 4 mg. IM: 1-2 mg (If no vascular access)
• Cardioversion/Pacing/Sedation:
IV/IO: 0.5-2 mg, may repeat at 10 min, max total dose 2 mg. IM: 2 mg (If no vascular access)
• Agitation/anxiety/behavioral Emergency:
IV/IO: 0.5-2 mg, may repeat at 10 min, max total dose 2 mg. IM: 2 mg (If no vascular access)
Pediatrics:
• Status Epilepticus:
IV/IO/IM: 0.1 mg/kg, repeat at 5-10 min PRN, max total dose 2 mg
• Cardioversion/Pacing/Sedation:
IV/IO: 0.05-0.1 mg/kg, SIVP over 2 min, max total dose 2 mg. IM: 0.1 mg/kg, max total dose 2 mg.
• Sedation for mechanical ventilation Adult/ Peds:
IV/IO: 0.05 mg/kg, titrate to sedation, repeat at 10 min PRN,
max single dose 2 mg, max total dose 4 mg.

Question 7

Lorazepam Onset/ Duration

Answer 7

• Onset: IV–5-15 min. IM–highly variable, 20-30 min.

* Duration: IV–6-8 hours. IM–24-48 hours

Question 8

Lorazepam Side Effects

Answer 8

Minor:
• CNS Depression
• Dizziness
• Drowsiness
• Lethargy
• Ataxia
Major:
• Respiratory Depression
• Apnea
• Hypotension
• Bradycardia
• Cardiac Arrest
• Paradoxical CNS stimulation (i.e. Valium Rage)

Question 9

Lorazepam Interactions

Answer 9

• Potentiates sedative effect of other CNS depressants.