Mosby's 2014 Nursing Drug Reference (128 page)

•
Adult: PO
2-10 mg bid-qid;
IM/IV
2-5 mg q3-4hr

• Geriatric: PO
1-2 mg daily-bid, increase slowly as needed

• Child >6 mo: PO
1-2.5 mg tid/qid;
IM/IV
0.04-0.3 mg/kg/dose q2-4hr, max 0.6 mg/kg in an 8-hr period

•
Adult: IV
5-15 mg 5-10 min precardioversion

•
Adult: IV
2.5-20 mg;
IM
5-10 mg 1/2 hr preendoscopy

•
Adult: PO
2-10 mg tid-qid or
EXT REL
15-30 mg/day;
IV/IM
5-10 mg, repeat in 2-4 hr

• Geriatric: PO
2-5 mg bid-qid;
IV/IM
2-5 mg, may repeat in 2-4 hr

• Child >5 yr: IM/IV
5-10 mg q3-4hr prn

• Infant >30 days: IM/IV
1-2 mg q3-4hr prn

•
Adult: IV/IM
5-10 mg, 2 mg/min, may repeat q10-15min, max 30 mg; may repeat in 2-4 hr if seizures reappear

• Child >5 yr: IM
1 mg q2-5min;
IV
1 mg slowly

• Child 1 mo-5 yr: IV
0.2-0.5 mg slowly;
IM
0.2-0.5 mg slowly q2-5min up to 5 mg, may repeat in 2-4 hr prn

•
Adult: RECT
0.2 mg/kg, may repeat in 4-12 hr

• Child 6-11 yr: RECT
0.3 mg/kg, may repeat in 4-12 hr

• Child 2-5 yr: RECT
0.5 mg/kg, may repeat in 4-12 hr

•
Adult: IV
10 mg initially then 5-10 mg q3-4hr prn

•
Adult: PO
Taper 0.5-2 mg over 4-16 wk

• Child 6 mo-5 yr: PO
0.33 mg/kg q8hr until afebrile for ≥24 hr

• 
With food or milk for GI symptoms; crushed if patient is unable to swallow medication whole

• 
Reduced opioid dose by 1/3 if given concomitantly with diazepam

• 
Concentrate:
use calibrated dropper only; mix with water, juice, pudding, applesauce; to be consumed immediately

Increase:
diazepam effect—amiodarone, protease inhibitors, diltiazem, cimetidine, clarithromycin, dalfopristin, quinupristin, delavirdine, disulfiram, efavirenz, erythromycin, fluconazole, fluvoxaMINE, imatinib, itraconazole, ketoconazole, IV miconazole, nefazodone, niCARdipine, ranolazine, troleandomycin, verapamil, voriconazole, zafirlukast, zileauton, valproic acid

Increase:
toxicity—barbiturates, SSRIs, cimetidine, CNS depressants, valproic acid, CYP3A4 inhibitors

Increase:
CNS depression—CNS depressants, alcohol

Decrease:
diazepam metabolism—oral contraceptives, valproic acid, disulfiram, isoniazid, propranolol

Decrease:
diazepam effect—CYP3A4 inducers (rifampin, barbiturates, carBAMazepine, ethotoin, phenytoin, fosphenytoin), smoking

Increase:
AST/ALT, serum bilirubin

• 
B/P (lying, standing), pulse; respiratory rate; if systolic B/P drops 20 mm Hg, hold product, notify prescriber; respirations q5-15min if given IV

• 
Blood studies: CBC during long-term therapy; blood dyscrasias (rare); hepatic studies: AST, ALT, bilirubin, creatinine, LDH, alk phos

• 
Degree of anxiety;
what precipitates anxiety and whether product controls symptoms

• 
Alcohol withdrawal symptoms,
including hallucinations (visual, auditory), delirium, irritability, agitation, fine to coarse tremors

•
 
Seizure control and type, duration, intensity of seizures

• 
For muscle spasms; pain relief

•
 
IV site for thrombosis or phlebitis, which may occur rapidly

• 
Mental status: mood, sensorium, affect, sleeping pattern, drowsiness, dizziness, suicidal tendencies

• 
Physical dependency, withdrawal symptoms:
headache, nausea, vomiting, muscle pain, weakness after long-term use

• 
Therapeutic response: decreased anxiety, restlessness, insomnia

• 
That product may be taken with food

• 
That product not to be used for everyday stress or for >4 mo unless directed by prescriber; to take no more than prescribed amount; that product may be habit forming

• 
To avoid OTC preparations unless approved by prescriber

• 
To avoid driving, activities that require alertness; drowsiness may occur

• 
To avoid alcohol, other psychotropic medications unless directed by prescriber; that smoking may decrease diazepam effect by increasing diazepam metabolism

•
 
Not to discontinue medication abruptly after long-term use; to gradually taper

• 
To rise slowly or fainting may occur, especially in geriatric patients

• 
That drowsiness may worsen at beginning of treatment

•
 
To notify prescriber if pregnancy is planned or suspected (D), avoid breastfeeding