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What is the brand name of diazepam?
Valium
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What drug class is Valium?
Benzodiazepine
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What's the mechanism of action for diazepam?
Intensifies GABA & suppresses the spread of seizure activity through the motor cortex of the brain. Manages stress, anxiety, and alcohol withdrawals. Effective as a premedication for minor orthopedic procedures due to it's muscle relaxant properties, also for cardioversion because it produces amnesia.
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What are the indications for Valium?
- seizures (status epilepticus)
- induce sedation prior to painful procedures
- acute anxiety
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What are some contraindications for diazepam?
- hypersensitivity
- shock
- coma
- acute alcohol intoxication
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What precautions need to be taken when administering Valium?
- Can cause local irritation so use a large vein.
- It's lipid solubility may allow seizures to reoccur.
- Use cautiously in patients with myasthenia gravis, impaired renal or hepatic function, ob patients, and the elderly.
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What are some side effects of diazepam?
Hypotension, drowsiness, tachycardia, ataxia, amnesia, slurred speech, edema, headache, dizziness, N/V, blurred vision, respiratory depression.
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What drug interactions are associated with Valium?
- Effects are enhanced when used in conjunction with other CNS depressants or alcohol.
- Cimetadine may increase diazepam plasma levels.
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What is the adult dose and route of diazepam?
5 mg IVP, may repeat @ 2.5 mg, q 5 minutes, prn, max 10 mg
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What is the pediatric dose and route of Valium?
- 0.1 mg/kg IV/IO, max single dose 5 mg
- 0.5 mg/kg PR, max single dose 10 mg
- May repeat once after 5 minutes
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What are the onset and half-life of diazepam?
- Onset= 1-5 minutes IV
- Half-life= 20-50 hours
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What drug is a benzodiazepine antagonist?
flumazenil (Romazicon)
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What drug class is lorazepam?
Benzodiazepine
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What is the mechanism of action of Ativan?
The most potent benzodiazepine. Acts as an anxiolytic, sedative, hypnotic,& skeletal muscle relaxant. It intensifies GABA. Has a short half life & is the prefered benzodiazepine in treating pediatric seizures.
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What are the indications for lorazepam?
- Seizures (status epilepticus)
- To induce sedation prior to painful procedures
- Anxiety
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What are the containdications for Ativan?
Hypersensitivity to benzodiazepines, acute narrow angle glaucoma, coma, shock, acute alcohol intoxication.
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What are some precautions in using lorazepam?
Renal or hepatic impairment, myasthenia gravis, COPD
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What are the side effects of Ativan?
Anteriograde amnesia, sedation, hypertension, hypotension, blurred vision, N/V, confusion
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What drug interactions can occur with the use of Ativan?
Effects of lorazepam will be increased when used in conjunction with other CNS depressants, alcohol, or cimetidine
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What is the adult dosage and route of lorazepam?
1-2 mg slow IVP/IM, q 5 minutes, max 8 mg
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What is the pediatric dose and route of Ativan?
- 0.1 mg/kg slow IVP/IM, max single dose 2 mg
- May repeat once after 5 minutes
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What is the onset and half life of lorazepam?
- Onset= 1-5 minutes IV, 5-10 minutes IM
- Half life= 10-20 hours
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What functional class is midazolam?
Benzodiazepine (short acting)
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What is the mechanism of action for Versed?
A short acting benzodiazepine that intensifies activity of GABA. Has CNS depressant, anticonvulsant & anterograde amnesic properties. Relaxes skeletal muscle & induces sleep.
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What are the indications for midazolam?
- Seizures (Status epileticus)
- To induce sedation prior to painful procedures
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What are the contraindications for Versed?
Hypersensitivity to benzodiazepines, acute narrow angle glaucoma, coma, shock, acute alcohol intoxication
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What precautions should be taken with midazolam?
Patients with COPD, CHF, and/or renal failure
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What are some side effects of Versed?
N/V, blurred vision, retrograde amnesia, excessive amnesia, apnea, hypotension, PVC'S
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What interactions does midazolam have?
Prolonged respiratory depression when given in conjunction with other CNS depressant such as alcohol. Cimetidine increases plasma levels of midazolam.
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What is the adult dose and route for Versed?
1-2.5 mg slow IVP/IM, q 5 minutes, until seizure is abolished
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What is the pediatric dose and route for midazolam?
0.1 mg/kg slow IVP/IM, max single dose 6 mg, may repeat once after 5 minutes.
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What is the onset, duration and half life of Versed?
- Onset= 3-5 minutes IV
- Duration= less than 2 hours IV
- Half life= 1-4 hours
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What functional class is Oxygen?
Oxidizer
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What is the mechanism of action for Oxygen?
A colorless, odorless, tasteless gas necessary for the breakdown of glucose into a usable energy form.
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Are there any contraindications for the use of Oxygen, if so what are they?
No
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What precautions should be used when administering Oxygen?
Use cautiously with COPD patients. Monitor long term use in neonates as retrolental fibroplasia may develop. Open flames.
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What is the dose and route for Oxygen?
25%-100%, inhalation with the appropriate BLS/ALS adjunct
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What is the percent increase in concentration of Oxygen per liter administered?
- 4%
- 1 lpm= 25%
- 2 lpm= 29%
- 10 lpm= 61%
- 15 lpm= 81%
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What functional class is atropine?
Parasympatholytic
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What is the mechanism of action for atropine?
Blocks muscarinic acetylcholine receptors and inhibits parasympathetic stimulation. Blocks vagal impulses to the heart and accelerates SA node discharge, enhances conduction through the AV junction, & increases cardiac output. Also is a potent bronchodilator when bronchoconstriction is caused by increased parasympathetic tone.
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What are the indications for use of atropine?
- Symptomatic bradycardia
- Asystole (brady/asystolic arrest)
- Bradycardic PEA
- Organophosphate/nerve agent poisoning
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What are the contraindications for the use of atropine?
None in the emergency setting
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What precautions need to be considered when administering atropine?
May worsen bradycardia associated with 2nd degree mobitz II & 3rd degree AV blocks, consider TCP 1st. Use with caution in patients with signs and symptoms of acute myocardial ischemia, MI or glaucoma.
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What are some side effects of atropine?
Blurred vision, dilated pupils, dry mouth, tachycardia, drowsiness, convulsions, hyper/hypotension, papitations, paradoxical bradycardia 9if given too slowly), AV dissociation, urinary retention.
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What drug interactions may be encountered with atropine?
Antihistamines, tricycliclic antidepressants, procainamide may lead to the anticholinergic effects of atropine.
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What are the adult & pediatric doses and routes of atropine for asystole/bradycardic PEA?
- Adult: 1 mg IVP, q 3-5 minutes, max total dose 0.04 mg/kg
- 2.0-2.5 mg ET, q 3-5 minutes
Pedi: 0.02 mg/kg IV/IO, min/max single dose of 0.1 mg/1.0mg, q 5 minutes, max total dose of 0.04 mg/kg
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What are the adult and pediatric doses and routes of atropine for symptomatic bradycardia?
Adult: 0.5 mg IVP, q 3-5 minutes, max total dose of 0.04 mg/kg
Pedi: 0.02 mg/kg IVP/IO, min/max single dose of 0.1 mg/1.0 mg q 5 minutes, max total dose of 0.04 mg/kg
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What are the doses and routes of atropine for organophosphate or nerve agent poisoning?
Adult: 2 mg IVP, q 5 minutes, prn
Pedi: 0.05-0.1 mg/kg IV/IM, min/max single dose 0.1 mg/5.0 mg, q 2-5 minutes, prn
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What is the absorption rate and half life for atropine?
- Absorption: 2-4 minutes IV
- Half life: 2-3 hours
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