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INTRODUCTION

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chlordiazepoxide (klor-dye-az-e-pox-ide)

Apo-Chlordiazepoxide, Libritabs, Librium, Mitran, Novopoxide, Poxi

Classification

Therapeutic: antianxiety agents, sedative/hypnotics

Pharmacologic: benzodiazepines

Schedule IV

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Indications
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Adjunct management of anxiety. Treatment of alcohol withdrawal. Adjunct management of anxiety associated with acute myocardial infarction.

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Action
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Acts at many levels of the CNS to produce anxiolytic effect. Depresses the CNs, probably by potentiating gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. Therapeutic Effects: Sedation. Relief of anxiety.

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Adverse Reactions/Side Effects
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CNS: dizziness, drowsiness, hangover, headache, mental depression, paradoxical excitation, sedation. EENT: blurred vision. GI: constipation, diarrhea, nausea, vomiting, weight gain. Derm: rashes. Local: pain at IM site. Misc: physical dependence, psychologic dependence, tolerance.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor daytime drowsiness and, “hangover” symptoms (headache, nausea, irritability, dysphoria). Repeated or excessive symptoms may require change in dose or medication.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Report any behavioral or personality changes such as decreased mental acuity or excessive excitation.

  • Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or increased body fat.

  • Monitor IM injection site for pain, swelling, and irritation. Report prolonged or excessive injectionsite reactions to the physician.

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Interventions
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  • Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall- prevention strategies, especially in older adults or if drowsiness and dizziness carry over into the daytime (See Appendix E).

  • Help patient explore nonpharmacologic methods to reduce anxiety, such as relaxation techniques, exercise, counseling, support groups, and so forth.

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Patient/Client-Related Instruction
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  • Instruct patients on prolonged treatment not to discontinue medication without consulting their physician. Prolonged use can cause tolerance and dependence, and abrupt withdrawal can cause insomnia, unusual irritability or nervousness, and seizures.

  • Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

  • Instruct patient to report other bothersome side effects such as severe or prolonged headache, blurred vision, skin rash, or GI problems (nausea, vomiting, diarrhea, constipation).

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Pharmacokinetics
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Absorption: Well absorbed from the GI tract. IM absorption may be slow and unpredictable.

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Distribution: Widely distributed. Crosses the blood-brain barrier. Crosses the placenta; enters breast milk. Recommend to discontinue drug or bottle feed.

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Metabolism and Excretion: Highly metabolized by the liver. Some products of metabolism are active as CNS depressants.

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Half-life: 5–30 hr.

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