Benzodiazepines/Antidotes

Dosage: 1G/kg mixed with at least 6-8oz of water then PO or via an NG tube

Administer only after emesis or in the cases where emesis is contraindicated

Acute ingested poisonings

Is specially prepared charcoal that will absorb and bind toxin from the gastrointestinal tract.

Absorbent

0.2mg IV over 30secs/min up to 1mg

Hepatic impairment, elderly, pregnant, nursing mothers, head injury, alcohol and drug dependency and physical dependence on benzodiazepines

Hypersensitivity to flumzenil or benzodiazepines; those patients who take medications for status epilepticus or seizures, seizure-prone pts during labor and delivery; tricycle antidepressant overdose.

Respiratory depression secondary to the benzodiazepines

Flumazenil is a benzodiazepine antagonist used to reverse the sedative and recall the psychomotor effects of diazepam, midazolam, and the other benzodiazepines.

Benzodiazepine Antagonist

• Adult: 0.4-2mg IV/IM/IN repeated 2-3 minutes as needed up to 10mg
• Pedi: 0.01mg IV//IM repeated every 2-3 minutes as needed up to 10 mg

Possible dependency(including newborns).  it also has a half life that is shorter then most narcotics; hence the pt may return to the overdose state.

Hypersensitivity to the drug, non-narcotic induced respiratory depression.

Narcotic and synthetic narcotic overdose; coma of unknown origin

Naloxone is a pure narcotic antagonist that blocks the effects of both natural and synthetic narcotics and may reverse respiratory depression.

Narcotic Antagonist

• Dosage/Route: Sedation: 2 to 4 mg IM,
• 0.5 to 2 mg IV

• Pedi:
• 0.03 to 0.5 mg/kg IV/IM/PR up to 4 mg.

Status Epilepticus: 2 mg slow IV/PR ( 2 mg/min.)

• Pedi:
• 0.1 mg/kg slow IV/PR ( 2 to 5 min.)

• Precautions: Narrow –angle glaucoma, depression or psychosis, coma,
• shock, acute alcohol intoxication, renal or hepatic impairment, organic brain
• syndrome, myasthenia gravis, GI disorders, elderly, debilitated, limited
• pulmonary reserve.

Contraindications: Sensitivity to benzodiazepines.

• Indications : Sedation
• for cardioversion and status epilepticus.

• Description: Lorazepam ( Ativan ) is the most potent benzodiazepine
• available. It has strong antianxiety, sedative, hypnotic, and skeletal relaxant
• properties. Also a relatively short half-life.

Sedative

Dosage/Route: 1 to 5 mg slow IV

Pedi: 0.05 to 0.2 mg/kg IV; 0.1 to 0.15 mg/kg IM

Intranasal: 3 mg

Precautions: COPD, renal impairment, CHF, elderly.

• Contraindications: Hypersensitivity to benzodiazepines, narrow-angle glaucoma,
• shock, coma, or acute alcohol intoxication.

• Indications: To
• induce sedation before cardioversion or intubation, and seizures.

• Description: Midazolam ( Versed ) is a short-acting benzodiazepine with
• CNS depressant, muscle relaxant, anticonvulsant, and anterograde amnestic
• effects.

Sedative

• Dosage/Route: Seizures: 5 to 10 mg
• IV/IM.
• Acute anxiety: 2 to 5 mg IV/IM Pedi: 0.5-2 mg IM
• Premedication: 5 to15 mg IV, Pedi: 0.2 to 0.5 mg/kg IV

• Contraindications: Hypersensitivity
• to the drug, shock, coma, acute alcoholism, depressed
• vital signs, obstetric patients, and neonates.

• Precautions: Psychoses, depression, myasthenia gravis. Due to a
• short-half life of the drug, seizure activity may recur.

• Indications:
• Major motor seizures, status epilepticus, premedication before cardioversion,
• muscle tremors due to injury, and acute anxiety.

• Description: Diazepam ( Valium ) is a benzodiazepine sedative and
• skeletal muscle relaxant that reduces tremors, induces amnesia, and reduces the
• incidence and recurrence of seizures. It relaxes muscle spasms in orthopedic
• injuries and produces amnesia for painful procedures  ( cardioversion).

Anti-anxiety, Hypnotic, Anti-convulsant, Sedative