Replace plunger into syringe body, gently pushing plunger until it stops. Note time given and continue to observe.Īfter use, pull on the syringe plunger until it is completely removed from the syringe body. Slowly count to 3 while holding the buttocks together to prevent leakage. Slowly count to 3 before removing the syringe from the rectum. Slowly count to 3 while gently pushing the plunger in until it stops. Gently insert syringe tip into rectum rim should be snug against rectal opening. Turn person on side facing you and bend upper leg forward to expose rectum. ![]() Lubricate rectal tip with lubricating jelly. Ensure that both the cap and seal pin are removed. To remove protective cover from syringe, push up with thumb and pull. Confirm dose is visible and correct, if known. Place the person on their side where they cannot fall. Grasp and push the locking ring upward to lock both sides of the ring. Confirm prescribed dose appears in the window. Grasp cap with the other hand and turn to adjust dose. To do so, hold barrel of the syringe with the cap pointed downward. Clinicians should be aware that the use of flumazenil may increase the risk of seizures.īefore dispensing to the patient, a pharmacist must dial in the dose and lock the rectal syringe. Tonic status epilepticus has been precipitated in patients treated with intravenous diazepam for petit mal status or petit mal variant status. In such cases, abrupt withdrawal of chronic diazepam may also be associated with a temporary increase in the frequency and/or severity of seizures in patients with a seizure disorder. Chronic daily use of diazepam may increase the frequency and/or severity of tonic-clonic seizures, requiring an increase in the dosage of standard anticonvulsant medication. Diazepam is not recommended for chronic, daily use as an anticonvulsant. During benzodiazepine withdrawal, the greatest risk of seizure appears to be during the first 24 to 72 hours. ![]() Patients with a seizure history or who are taking drugs that lower the seizure threshold (e.g., certain antidepressants, phenothiazines) should not be withdrawn abruptly from benzodiazepines due to the risk of precipitating a seizure. Subsequently, decrease the dosage more slowly. If a patient develops withdrawal reactions, consider pausing the taper or increasing the dosage to the previous tapered dosage level. No standard benzodiazepine tapering schedule is suitable for all patients therefore, create a patient-specific plan to gradually reduce the dosage. To reduce the risk of acute withdrawal reactions, use a gradual taper to reduce the dosage or to discontinue benzodiazepines. Benzodiazepine dependence can occur after administration of therapeutic doses for as few as 1 to 2 weeks and withdrawal symptoms may be seen after the discontinuation of therapy. The risks of physiological dependence and withdrawal increase with longer treatment duration and higher daily dose. ![]() Abrupt discontinuation or rapid dosage reduction of benzodiazepines after continued use may precipitate acute withdrawal reactions, which can be life-threatening. Advise patients to seek immediate medical attention if they experience symptoms such as trouble breathing. Abuse and misuse of benzodiazepines commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes, including respiratory depression, overdose, and death. Avoid or minimize concomitant use of CNS depressants or other medications associated with addiction or abuse. ![]() To discourage abuse, the smallest appropriate quantity of the benzodiazepine should be prescribed, and proper disposal instructions for unused drug should be given to patients. A potential risk of abuse should not preclude appropriate treatment in any patient, but requires more intensive counseling and monitoring. Assess patients for risks of addiction, abuse, or misuse before drug initiation, and monitor patients who receive benzodiazepines routinely for development of these behaviors or conditions. The use of benzodiazepines exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death. Use diazepam with caution in patients with a history of alcoholism or substance abuse due to the potential for psychological dependence. Abrupt discontinuation, alcoholism, benzodiazepine dependence, substance abuse
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