Generic name: DIAZEPAM Brand name: Valium, Diastat Classification: Benzodiazepine anticonvulsant; Anxiolytics Availability: 2mg, 5mg, 10mg

tablets, 1mg/ml, 5mg/ml, 5mg/5 ml oral solution, 5 mg/ml injection, 2.5 mg, 5 mg, 10 mg, 15 mg, 20 mg rectal gel Action: long-acting benzodiazepine psychotherapeutic agent. Benzodiazepines act at the limbic, thalamic, and hypothalamic regions on the CNS and produce CNS depression resulting in sedation, hypnosis, skeletal muscle relaxation, and anticonvulsant activity dependent on the dosage. Diazepam is a benzodiazepine that binds to a specific subunit on the GABA receptor at a site that is distinct from the binding site of the endogenous GABA molecule. The GABA receptor is an inhibitory channel which, when activated, decreases neuronal activity. Because of the role of diazepam as a positive allosteric modulator of GABA, when it binds to benzodiazepine receptors it causes inhibitory effects. This arises from the hyperpolarization of the post-synaptic membrane owing to the control exerted over negative chloride ions by GABAA receptors. Benzodiazepines including diazepam however, do not have any effect on the levels of GABA in the brain. Diazepam appears to act on areas of the limbic system, thalamus and hypothalamus, inducing anxiolytic effects. Its actions are due to the enhancement of GABA activity. Benzodiazepine drugs including diazepam increase the inhibitory processes in the cerebral cortex. A benzodiazepine that probably potentiates the effects of GABA, depresses the CNS & suppresses the spread of seizure activity Indication: relief of anxiety, agitation & tension due to psychoneurotic states & transient situational disturbances Uses: drug of choice for status epilepticus; management for anxiety disorders, for short term relief of anxiety symptoms, to allay anxiety and tension prior to surgery, cardioversion and endoscopic procedures, as an amnesic, and treatment for restless legs; also used to alleviate acute withdrawal symptoms of alcoholism, voiding problems in older adults, and adjunctively for relief of skeletal muscle spasm associated with cerebral palsy, paraplegia, athetosis, stiffman syndrome, tetanus. Used in the management of anxiety, agitation or tension. Contraindications: Acute narrow-angle glaucoma, untreated open-angle glaucoma; during or within 14 days of MAOI therapy; pregnancy (category D), lactation; injectable form: shock, coma, acute alcohol intoxication, depressed vital signs, obstetric patients, infants younger than 30 days of age SE: drowsiness, dizziness, tiredness, weakness, dry mouth, diarrhea, nausea, changes in appetite Adverse Reaction: dysarthria, slurred speech, tremor, transient amnesia, fatigue, ataxia, headache, insomnia, paradoxical anxiety, hallucination Nursing Responsibilities: Do not administer intra-arterially; may produce arteriospasm, gangrene. Change from IV therapy to oral therapy as soon as possible. Do not use small veins (dorsum of hand or wrist) for IV injection. Reduce dose of narcotic analgesics with IV diazepam; dose should be reduced by at least one-third or eliminated.

Carefully monitor pulse, BP, respiration during IV administration. Maintain patients receiving parenteral benzodiazepines in bed for 3 hr; do not permit ambulatory patients to operate a vehicle following an injection. Monitor EEG in patients treated for status epilepticus; seizures may recur after initial control, presumably because of short duration of drug effect. Monitor liver and kidney function, CBC during long-term therapy. Taper dosage gradually after long-term therapy, especially in epileptic patients. Arrange for epileptic patients to wear medical alert ID indicating that they are epileptics taking this medication. Discuss risk of fetal abnormalities with patients desiring to become pregnant. ORAL: ensure that sustained release form is not chewed or crushed; it must be swallowed whole; give other tablets crushed with fluid or mixed with food if necessary; supervise oral ingestion to ensure drug is swallowed; avoid abrupt discontinuation of diazepam; taper doses to termination. IM: give deep into large muscle mass; inject slowly; Rotate injection sites IV: do not dilute or mix with any other drug; inject drug slowly; avoid small veins and take extreme care to avoid intra-arterial administration or extravasation Assess IV site during administration Assess level of anxiety, what precipitates anxiety and if drug control symptoms Assess for alcohol withdrawal symptoms: hallucinations, delirium, irritability, agitation, tremors Assess for seizure control, type, type, duration and convulsion intensity Assess mental status: mood, sensorium, affect, sleep pattern, drowsiness, dizziness. Report changes of mental status Monitor for adverse reactions. Most are dose related Observe necessary preventive precautions for suicidal tendencies that may be present in anxiety states accompanied by depression Observe patient closely and monitor vital signs when diazepam is given parentally; hypotension, muscular weakness, tachycardia, and respiratory depressi9on may occur Supervise ambulation. Adverse reactions such as drowsiness and ataxia are more likely to occur in older adults and debilitate or those receiving larger doses. Dosage adjustment may be necessary Monitor I&O ratio Avoid alcohol and other CNS depressants during therapy unless otherwise advised by the physician. Concomitant use of these agents can cause severe drowsiness, respiratory depression, apnea Do not drive or engage in other potentially hazardous activity or those requiring mental precision until reaction to drug is known Tell physician if patient intends to become pregnant during therapy; drug may need to be discontinued