Clonazepam

INTRODUCTION

Indications

Prophylaxis of Petit mal, Petit mal variant, Akinetic, Myoclonic seizures. Panic disorder with or without agoraphobia. Unlabeled Use: Uncontrolled leg movements during sleep. Neuralgias. Sedation. Adjunct management of acute mania, acute psychosis, or insomnia.

Action

Anticonvulsant effects may be due to presynaptic inhibition. Produces sedative effects in the CNS, probably by stimulating inhibitory gamma-aminobutyric acid (GABA) receptors. Therapeutic Effects: Prevention of seizures. Decreased manifestations of panic disorder.

Adverse Reactions/Side Effects

CNS: behavioral changes, drowsiness, fatigue, slurred speech, sedation, abnormal eye movements, diplopia, nystagmus. Resp: increased secretions. CV: palpitations. GI: constipation, diarrhea, hepatitis, weight gain. GU: dysuria, nocturia, urinary retention. Hemat: anemia, eosinophilia, leukopenia, thrombocytopenia. Neuro: ataxia, hypotonia. Misc: fever, physical dependence, psychologic dependence, tolerance.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• In patients with seizures, document the number, duration, and severity of seizures to help determine drug efficacy.

• Monitor daytime drowsiness, short-term memory deficits, behavioral changes, slurred speech, and “hangover” symptoms (headache, nausea, malaise, irritability, dysphoria). Repeated or excessive symptoms may require change in dose or medication.

• Assess balance and risk of falls (See Appendix E), especially in older adults, or in patients exhibiting sedation, dizziness, ataxia, or visual disturbances.

• Monitor signs of eosinophilia (fatigue, weakness, myalgia), leukopenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician.

• If treating neuralgia, use visual analog scales and other appropriate pain scales to assess the patient's pain and help document effects of drug therapy.

• Monitor motor function and report an excessive decrease in muscle tone (hypotonia) or problems with coordination (ataxia).

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

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fallprevention strategies, especially in older adults or if drowsiness, ataxia, or visual disturbances affect gait and balance (See Appendix E).

• Help patient explore nonpharmacologic methods to decrease anxiety and reduce panic attacks, such as relaxation techniques, regular exercise, avoid caffeine, and so forth.

Patient/Client-Related Instruction

• Instruct patients on prolonged treatment not to discontinue medication without consulting their physician. Long-term use can cause tolerance and physical/psychologic 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 severe or prolonged GI problems (constipation, diarrhea), and to watch for ...