| Name: |
LORAZEPAM (AtivanR) |
| Classification: |
anxiolytic agent; sedative; anticonvulsant
- used in the initial control of seizures or in the treatment of status epilepticus
- has no long-term anticonvulsant activity
- useful in the management of alcohol withdrawal and delirium tremens
- muscle relaxant - useful in patient with tetanus
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| Dose: |
- Bolus:
- 0.044 mg/kg IV direct (up to 2 mg) q 1-8h; titrate to individual need
- (generally sufficient for adequate sedation in most patients; this dose should not be exceeded in patients older than 50 years)
- Infusion:
- initiate at 1-3 mg/hr and adjust according to effect and target VAMAAS (tolerance may occur)
- anticonvulsant:
- 0.05 mg/kg IV (up to 7 mg) which can be repeated in 5 min
|
| Administration: |
- IV Direct:
- dilute with equal volume of IV solution and inject at a rate not greater than 2 mg/min
- IV Infusion:
- 4 mg/mL undiluted in syringe or in viaflex bag
- intermittent administration prefered over continuous infusion due to poor stability and adherence of lorazepam to PVC bags and tubing
- ampoules must be refrigerated and protected from light for long term storage
|
| Adverse Effects: |
- respiratory depression and partial airway obstruction, especially when combined with narcotics
- hypotension
- paradoxical reactions (irritability, excitability); may make depression or psychosis worse
- amnesia, lack of recall
- pain and redness at the injection site
|
| Antidote: |
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| Drug Interactions: |
- lorazepam + other CNS depressants = increased sedation
- lorazepam + scopolamine = increased sedation, hallucinations
|
| Monitoring Therapy: |
- blood pressure
- respiratory rate
- response to sedation
|
| Adult Critical Care Protocol: |
- May be administered IV direct or by IV infusion by a nurse in Adult Critical Care
- May be titrated by a nurse in Adult Critical Care.
- Continuous infusions must be administered by infusion device and the pump library must be enabled.
- Order written to provide sedation during mechanical ventilation should be discontinued when patient is not longer receiving mechanical ventilation support.
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