lithium carbonate

Drug Data Classification Mechanism of Action Indication Contraindications Adverse Reaction Nursing ResponsibilitiesGeneric Name:DIAZEPAM

Trade/Brand Name: Apo-Diazepam, Diastat, Diazemuls,Novodipam, PMS-Diazepam, Valium, Vivol

Minimum Dose:Antianxiety (Adult)PO 1 mg 2-4x dailyIM, IV 1 mg q3-4h

Alcohol Withdrawal (Adult)PO 5 mg tid/qidIM IV 5 mg q3-4h

Psychoneurotic Reactions (Adult)IM, IV 2 mg q3-4h

Maximum Dose:Antianxiety (Adult)PO 10 mg 2-4x dailyIM, IV 10 mg q3-4h

Alcohol Withdrawal (Adult)PO 10 mg tid/qidIM IV 10 mg q3-4h

Psychoneurotic Reactions (Adult)IM, IV 10 mg q3-4h

Availability: Tablet, Oral Solution, Rectal Pediatric Gel, Injection

Route(s) of

Therapeutic:Antiaxciety agentAnticonvulsantSedative/HypnoticsSkeletal Muscle Relaxant (centrally acting)

Pharmacologic Class:Benzodiazepine

Pregnancy Risk Category: D- There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk

Diazepam is a long-acting benzodiazepine with anticonvulsant, anxiolytic, sedative, muscle relaxant and amnestic properties. It increases neuronal membrane permeability to chloride ions by binding to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron within the CNS and enhancing the GABA inhibitory effects resulting in hyperpolarisation and stabilisation.Absorption: Readily and completely absorbed from the GI tract, peak plasma concentrations after 30-90 min (oral). Rapidly absorbed, peak plasma concentrations after 10-30 min (rectal).Distribution: Readily crosses the blood-brain barrier; redistributed into fat depots and tissues. Protein-binding: 98-99%.Metabolism: Extensively hepatic; converted to desmethyldiazepam, oxazepam and temazepam.Excretion: Urine (as free or conjugated metabolites). Elimination half-life: Rapid (initial), 1-2 days (terminal), 2-5 days (desmethyldiazepam).

Pharmacokinetics Route Onset Peak DurationPO 30-60 min 1-2h 24hIM 20 min 0.5-1.5h unknownIV 1-5min 15 -30

General Indication:Adjunct in the management of: Anxiety Disorder, Athetosis, Anxiety relief prior to cardioversion (injection), Stiffman Syndrome, Preoperative Sedation, Conscious Sedation (provides light anesthesia andanterogade amnesia). Treatment of status epilipticus/ uncontrolled seizures (injection). Skeletal MuscleRelaxant. Unlabeled Uses: Anxiety associated with acute myocardial infarction, insomnia.

Hypersensitivity; Cross-sensitivity with otherbenzodiazepines may occur; Comatose Patients;Pre-existing CNS Depression; Uncontrolled Severe Pain; Angle-Closure Glaucoma; Pregnancy or Lactation; Some products contain alcohol, propylene glycol, or tartrazine and should be avoided in patients with known hypersensitivity or intolerance; OB: Increased risk of congenital malformations; Lactation: Recommend to discontinue drug or bottle-feed

PrecautionsHepatic Dysfunction; Severe Renal Impairment;Severe Pulmonary Imparment; History of SuicideAttempt or Drug dependence; Debilitated patients(dose reduction required); Patients with low albumin; Pedi: Metabolites can accumulate in neonates. Injection contains benzyl alcohol which can cause potentially fatal gasping syndrome in neonates. Geri: Long-acting benzodiazepines cause prolonged sedation in the elderly. Appears on Beers list and is associated with increased risk of falls (decreased dose required or consider short-acting benzodiazepine)

Drug-drug InteractionIncreased clearance of diazepam when used with phenytoin, carbamazepine and phenobarbital. Reversible deterioration of parkinsonism may occur when given together with levodopa. Combination with lithium may produce hypothermia. May need to

CNS: dizziness, drowsiness, lethargy, depression, hangover, ataxia, slurred speech, headache, paradoxical excitation

EENT: blurred vision

Resp: Respriatory depression

CV: Hypotension (IV only)

GI: constipation, diarrhea (may be caused by propylene glycol content in oral solution), nausea, vomiting, weight gain

Derm: Rashes

Local: pain (IM), phlebitis (IV), venous thrombosis

Misc: physical dependence, psychological dependence, tolerance

Before:1.) Verify order on

Patient’s Chart2.) Know Reason for

giving drug3.) Advise patient to

notify Health Care Professional of medication regiment prior to treatment

4.) Obtain baseline Vital Signs

5.) Check for Hypersensitivity to Benzodiazepenes

6.) Check for Pregnancy/ Lactation

7.) Check IV Site for Patency for IV drug

8.) Observe and record intensity, duration and location of seizure activity.

During:1.) Verify client’s

identity2.) Inform Client about

purpose of the drug

3.) Give right dose at right ordered time

4.) Assess IV site frequenty; diazepam causes phlebitis and venous thrombosis

5.) Advise not to take Grapefruit Juice, Kava Kaya, Valerian or Chamomile while taking this drug

6.) Check Vital Signs

After:1.) Document

appropriately2.) Dispose of used

materials3.) Instruct to take full

course of therapy as indicated

4.) Advise patient not to share medication with

Administration:Oral, Parenteral, Rectal

Source: J. Deglin 2009, Davis’ Drug Guide for Nurses, 12th ed, F.A. Davis Company, pp. 404-408


min 15-60min



reduce dose of narcotics when used concurrently.

Drug-Food InteractionGrapefruit juice may increase serum levels and toxicity of diazepam. Levels may be reduced by St John's wort. Concomitant use of kava kava, valerian, or chamomile can increase CNS depression



others5.) Observe and

record intensity, duration and location of seizure activity.

6.) Instruct to call nurse/physician if adverse effects occur

7.) Observe depressed patients closely for suicidal tendencies

8.) Assess patient experiencing alcohol withdrawal for tremors, agitation, delirium and hallucinations. Protect patient from injury.

9.) Check Vital Signs


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lithium carbonate

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