Lorazepam Drug Study

In making a Drug Study, the following elements must be present: Generic Name and the Brand name (not all brands, just the brand used by the patient), Action, Indication, Pregnancy Category, Drug Classification, and Contraindication, Adverse Effect, Drug interaction and Nursing Consideration/Intervention…. Most clinical instructors preferred this to be in a long bond paper in printed or handwritten with paper in landscape.

Lorazepam

Brand Name: Apo-Lorazepam (CAN), Ativan, Novo-Lorazem (CAN), Nu-Loraz (CAN)

Pregnancy Category D, C-IV controlled substance

Drug classes: Benzodiazepine, Antianxiety agent, Sedative/hypnotic

Therapeutic actions

Exact mechanisms are not understood; acts mainly at subcortical levels of the CNS, leaving the cortex relatively unaffected. Main sites of action may be the limbic system and reticular formation; benzodiazepines potentiate the effects of GABA, an inhibitory neurotransmitter; anxiolytic effects occur at doses well below those necessary to cause sedation and ataxia.

Indications

· Management of anxiety disorders or for short-term relief of symptoms of anxiety or anxiety associated with depression (oral)

· Preanesthetic medication in adults to produce sedation, relieve anxiety, and decrease recall of events related to surgery (parenteral)

· Unlabeled parenteral use: management of status epilepticus, chemotherapy-induced nausea and vomiting, acute alcohol withdrawal

Contraindications

· Contraindicated with hypersensitivity to benzodiazepines, propylene glycol, polyethylene glycol or benzyl alcohol (parenteral lorazepam); psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication with depression of vital signs; pregnancy (crosses placenta; risk of congenital malformations and neonatal withdrawal syndrome); labor and delivery ("floppy infant" syndrome); and lactation.

Adverse effects

Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, light-headedness, disorientation, anger, hostility, episodes of mania and hypomania, restlessness, confusion, crying, delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty concentrating, vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild paradoxical excitatory reactions during first 2 wk of treatment

Bradycardia, tachycardia, CV collapse, hypertension and hypotension, palpitations, edema

Urticaria, pruritus, rash, dermatitis

Visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion

Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, hepatic dysfunction

Incontinence, urinary retention, changes in libido, menstrual irregularities

Elevations of blood enzymes: LDH, alkaline phosphatase, AST, ALT; blood dyscrasias: agranulocytosis, leukopenia

Hiccups, fever, diaphoresis, paresthesias, muscular disturbances, gynecomastia. Drug dependence with withdrawal syndrome when drug is discontinued; more common with abrupt discontinuation of higher dosage used for > 4 mo

Drug Interactions:

· Increased CNS depression with alcohol and other sedating medications, such as barbiturates and opioids

· Decreased effectiveness with theophyllines

Nursing considerations

CLINICAL ALERT!

Name confusion has occurred between lorazepam and alprazolam; use caution.

· Be aware that SL administration has more rapid absorption than PO, and bioavailability compares to IM use.

· Do not administer intra-arterially; arteriospasm, gangrene may result.

· Give IM injections of undiluted drug deep into muscle mass, monitor injection sites.

· Do not use solutions that are discolored or contain a precipitate. Protect drug from light, and refrigerate oral solution.

· Keep equipment to maintain a patent airway on standby when drug is given IV.

· Reduce dose of opioid analgesics by at least half in patients who have received parenteral lorazepam.

· Keep patients who have received parenteral doses under close observation, preferably in bed, up to 3 hr. Do not permit ambulatory patients to drive following an injection.

· Taper dosage gradually after long-term therapy, especially in epileptic patients.