ACTIVE LEARNING TEMPLATE: Medication Lorazepam (Ativan) MEDICATION __________________________________________________________________________ Benzodiazepines CATEGORY CLASS ______________________________________________________________________ REVIEW MODULE CHAPTER ___________ PURPOSE OF MEDICATION Expected Pharmacological Action Benzodiazepines enhance inhibitory effects of GABA. Relief from anxiety occurs rapidly following administration. Short-term use recommended due to potential for dependence. Therapeutic Use -Generalized anxiety disorder and panic disorder -Other uses: seizure disorder, insomnia, muscle spasm, alcohol withdrawal (prevention and treatment for acute manifestations), induction of anesethesia, hyperarousal manifestaions of disscociative disorders Complications -CNS depression: sedation, lightheaded, ataxia, decreased cognitive function -Retrograde amnesia -Toxicity -Paradoxical response: insomnia, excitation, euphoria, anxiety, rage -WIthdrawal effects: anxiety, diaphoresis, tremors Medication Administration PO (Adults): Anxiety - 1-3 mg 2-3 times daily (up to 10 mg/day). Insomnia - 2-4 mg at bedtime PO (Geriatric Patients or Debillitated Patients): Anxiety - 0.5-2 mg/day in divided doses initially. Insomnia - 0.25-1 mg initially as needed. PO (children): Anxiety/sedation - 0.02-0.1 mg/kg/dose (not to exceed 2 mg) q 4-8 hrs. Preoperative sedation - 0.02-0.09 mg/kg/dose Contraindications/Precautions -Pregnancy risk category D -Schedule IV controlled substance -Contrindicated in clients who have sleep apnea, respiratory depression or glaucoma -Use cautiously in older clients and those with liver disease or history of substance abuse -Short term use due to risk for dependence Interactions -CNS depressants (alcohol, barbiturates, opiods) can result in respiratory depression. Anticonvulsants and antihistamines can cause CNS depression -Grape fruit juice can reduce metabolism -high fat meals can reduce absorption Evaluation of Medication Effectiveness Depending on therapeutic intent, effectiveness is evidenced by: -verbalizing feeling less anxious and more relaxed -improved mood -maintaining regular sleep pattern -greater ability to cope with manifestations in social and occupational interactions -improved ability with manifestations of identified stressors Nursing Interventions -For oral toxicity, gastric lavage used followed by administration of activated charcoal or saline cathartics -Administer medication with meals or snacks if GI upset occurs -Administer medication at bedtime, if possible due to sedation -Monitor vital signs, maintain patient airway, provide fluids to maintain blood pressure -Have resuscitation equipment available Client Education -Advise clients that dependency can develop during or after treatment. Notify HCP if withdrawal symptoms occur -Advise clients to swallow sustained release tablets and do not crush or chew -Advise client to keep in a secure location due to abuse potential -Avoid grapfruit juice -Don't take with fatty foods