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Lorazepam
trade name
Ativan
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Lorazepam
class
- Benzodiazepine
- Sedative
- Anti-anxiety (anxiolytic)
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Lorazepam
mechanism of action
Most potent of all Benzodiazepines; its effects (anxiolytic, sedative, hypnotic, and skeletal muscle relaxant) are all mediated by increasing the levels of the inhibitory neurotransmitter GABA. GABA works mostly at the hypothalamus, limbic system and thalamus in the brain.
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Lorazepam
indications
- 1. status epilepticus
- 2. sedation prior to cardioversion/pacing
- 3. anxiety
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Lorazepam
contraindications
- 1. pregnancy or nursing mothers
- 2. Use with caution in shock, coma, acute alcohol intoxication, suicidal patients and those with depressed respirations.
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Lorazepam
side effects
CNS: Anterograde amnesia, drowsiness, sedation, dizziness/disorientation, confusion, Hallucinations (found frequently in elderly patients), restlessness
Cardiovascular: hypertension or hypotension
GI: nausea/vomiting, abdominal discomfort
Other: depressed hearing
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Lorazepam
precautions
Use further care when administering Ativan to patients with renal or hepatic impairment; the elderly or debilitated; and those with psychosis
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Lorazepam
interactions
Alcohol, CNS depressants, and anticonvulsants may potentiate CNS depression; may also increase Dilantin levels; and smoking decreases sedative and anti-anxiety effects.
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Lorazepam
routes
IV, IO, IM, PR
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Lorazepam
onset and duration
Onset is 1-5 min IV, 15-30 min IM; peak effects in 15-20 mins IV, 2 hrs IM; duration 6-8 hours.
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Lorazepam
dosages
- Sedation for Cardioversion:
- Adult: 2-4 mg IM, or 0.5-2 mg IV
- Pediatric: 0.03 mg-0.05 mg/kg IV/IM/PR max dose of 4mg
- Seizure Management:
- Adult: 2 mg slow IV (1mg/min) – repeat half dose if needed in 2-5 mins
- Pediatric: 0.1 mg/kg slow IV (over 2-5 mins); repeat half dose if needed in 2-5 minutes (Can be given PR to children if no IV obtained)
Riverside County Protocol: Not in Riverside County Protocol
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Lorazepam
notes
Keep benzodiazepine antagonist (i.e. Romazicon) nearby; patient over 50 years of age have frequent incidents of psychosis with Ativan administration do exceed 2 mg initial dose
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