Diazepam

INTRODUCTION

Indications

Adjunct in the management of Anxiety Disorder, Athetosis, Anxiety relief prior to cardioversion (injection), Stiff man syndrome, Preoperative sedation, Conscious sedation (provides light anesthesia and anterograde amnesia). Treatment of status epilepticus/uncontrolled seizures (injection). Skeletal muscle relaxant. Management of the symptoms of alcohol withdrawal. Unlabeled Use: Anxiety associated with acute myocardial infarction, insomnia.

Action

Depresses the CNS, probably by potentiating gammaaminobutyric acid (GABA), an inhibitory neurotransmitter. Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways. Has anticonvulsant properties due to enhanced presynaptic inhibition. Therapeutic Effects: Relief of anxiety. Sedation. Amnesia. Skeletal muscle relaxation. Decreased seizure activity.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, lethargy, depression, hangover, ataxia, slurred speech, headache, paradoxical excitation. EENT: blurred vision. Resp: respiratory 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, psychologic dependence, tolerance.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• When used as a muscle relaxant, assess patient's muscle spasms, associated pain, and range of motion to help document drug efficacy.

• In patients with seizures, document changes in seizure activity to help determine drug efficacy.

• Assess dizziness, drowsiness, and ataxia 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.

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

• Be alert for a possible increase in excitation or worsening anxiety and agitation. Severe or problematic excitation may require a change in dose or drug.

• Measure blood pressure (sitting, standing, lying) and pulse rate, especially when patient begins drug therapy or when administered IV for severe or uncontrolled seizures. Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• Monitor any breathing problems, and report signs of respiratory depression such as shortness of breath, cyanosis, and labored or difficult breathing.

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

• Assess injection site during and after IV or IM administration. Report any localized pain or signs of phlebitis and venous thrombosis (swelling, inflammation).

Interventions

• In patients with muscle spasms, implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to help resolve the spasms and reduce the need for long-term drug treatment and ...