Lorazepam

INTRODUCTION

Indications

Anxiety disorder (oral). Preoperative sedation (injection). Decreases preoperative anxiety and provides amnesia. Unlabeled Use: IV: Antiemetic prior to chemotherapy. Insomnia, panic disorder, as an adjunct with acute mania or acute psychosis.

Action

Depresses the CNS, probably by potentiating gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. Therapeutic Effects: Sedation. Decreased anxiety. Decreased seizures.

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness, lethargy, hangover, headache, ataxia, slurred speech, forgetfulness, confusion, mental depression, rhythmic myoclonic jerking in preterm infants, paradoxical excitation. EENT: blurred vision. Resp: respiratory depression. CV: rapid IV use only: APNEA, CARDIA CARREST, bradycardia, hypotension. GI: constipation, diarrhea, nausea, vomiting, weight gain (unusual). Derm: rashes. Misc: physical dependence, psychologic dependence, tolerance.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess respiration after rapid IV administration. Notify physician immediately if patient exhibits any interruption in respiratory rate (apnea) or signs of respiratory depression such as rapid labored breathing, cyanosis, confusion, irritability, sleepiness, headache, and oxygen desaturation. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function.

• Continually monitor for signs of cardiac arrest, especially after rapid IV administration. Signs include sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, nausea, and loss of consciousness. Seek immediate medical assistance if patient develops these signs.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report an unusually slow heart rate (bradycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

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

• Report any behavioral or personality changes such as confusion, forgetfulness, slurred speech, decreased mental acuity, or excessive excitation.

• 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.

Interventions

• 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).

• Because of the risk of cardiac arrest and respiratory depression, use extreme caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, ...