Medication

Diazepam
Brand name: Valium

Classification

Benzodiazepine
Antiepileptic
Skeletal muscle
relaxant
(centrally acting)
Anxiolytic

Action
Exact
mechanisms of
action not
understood; acts
mainly
at the limbic
system and
reticular
formation;
may act in spinal
cord and
at supraspinal
sites to produce
skeletal muscle
relaxation; potenti
ates the effects of
GABA, an
inhibitory
neurotransmitter;
anxiolytic effects
occur at doses
well below those
necessary to
cause sedation,
ataxia; has little
effect on cortical
function.

Drug Study
Clients
Contraindication
Indication
Management of
anxiety disorders or
for short-term relief
of symptoms of
anxiety.
Acute alcohol
withdrawal; may be
useful in
symptomatic relief
of acute agitation,
tremor, delirium
tremens,
Hallucinosis.
Muscle relaxant:
Adjunct for relief of
reflex skeletal
muscle spasm due
to local pathology
(inflammation of
muscles or joints)
or secondary to
trauma;
spasticity caused
by upper motor
neuron disorders
(cerebral palsy and
paraplegia);
athetosis, stiff-man
syndrome
Parenteral:

Contraindicated with
hypersensitivity
to benzodiazepines;
psychoses, acute
narrow-angle
glaucoma, shock,
coma, acute alcoholic
intoxication;
pregnancy (cleft lip or
palate, inguinal
hernia, cardiac
defects,
microcephaly,
pyloric stenosis
when used in first
trimester; neonatal
withdrawal syndrome
reported in newborns);
lactation.
Use cautiously with
elderly or debilitated
patients; impaired liver
or renal function; and
in patients with a
history of substance
abuse.

Adverse Effects
Body as a
Whole: Throat and
chest pain.

Nursing Responsibilities

Monitor for adverse reactions.

Most are dose related. Physician

will rely on accurate observation
and reports of patient response
to the drug to determine lowest
effective maintenance dose.

CNS:
Drowsiness,
fatigue, ataxia,
confusion, paradoxic
rage, dizziness, vertigo, Monitor for therapeutic
amnesia, vivid dreams,
effectiveness. Maximum effect
headache, slurred
may require 12 wk; patient
speech, tremor; EEG
tolerance to therapeutic effects
changes, tardive
may develop after 4 wk of
dyskinesia.
treatment.
CV:
Hypotension
tachycardia,
edema, cardiovascular
collapse.

Observe necessary preventive

Special Senses:
Blurred vision, diplopia,
nystagmus.

Observe patient closely and

GI: Xerostomia,
nausea, constipation,
hepatic dysfunction.

precautions for suicidal

tendencies that may be present
in anxiety states accompanied
by depression.

monitor vital signs when

diazepam is given parenterally;
hypotension, muscular
weakness, tachycardia, and
respiratory depression may
occur.

Urogenital:Incontinenc Supervise ambulation. Adverse

e, urinary retention,
reactions such as drowsiness
gynecomastia
and ataxia are more likely to
(prolonged use),
occur in older adults and

Treatment of
tetanus

menstrual irregularities,
ovulation failure.

Antiepileptic:
Adjunct in
status epilepticus a
nd severe recurrent
convulsive seizures
(parenteral);
adjunct in seizure
disorders (oral)

Monitor I&O ratio, including urinary

Respiratory:
and bowel elimination.
Hiccups,
coughing, laryngospasm
.

Preoperative
(parenteral): Relief
of anxiety and
tension and to
lessen recall in
patients prior to
surgical
procedures, cardiov
ersion,
and endoscopic pro
cedures
Rectal:
Management of
selected, refractory
patients with
epilepsy who
require intermittent
use to control bouts
of increased
seizure activity

Other: Pain, venous

thrombosis, phlebitis at
injection site.

debilitated or those receiving

larger doses. Dosage
adjustment may be necessary.