Sedative Hypnotics

Section 8 - MEDICATION GUIDELINES

8.15 SEDATIVE / HYPNOTICS / ANTIPSYCHOTIC

Diazepam (VALIUM) / Sedative Hypnotic

DESCRIPTION

• It is a skeletal muscle relaxant that reduces tremors, induces amnesia, and reduces the incidence and recurrence of seizures.

INDICATIONS

• Seizures, Status Epilepticus, premedication prior to cardioversion, acute anxiety states, acute alcohol withdrawal.

CONTRAINDICATIONS

• Hypersensitivity to the medication.

PRECAUTIONS

• Due to a short half-life of the drug, seizure activity may recur.

DOSAGE

• 2 - 20 mg Slow IVP for adults titrated to effect. If no IV access, administer 10 - 20 mg IM up to a total of 2 ml per large muscle injection site or 1 ml per small muscle injection site. Refer to PRACTICE PARAMETER for specific dosages.
• Refer to Handtevy System for pediatric dosage.

Midazolam (VERSED) / Sedative / Hypnotic

DESCRIPTION

• It is a skeletal muscle relaxant that reduces tremors, induces amnesia, and reduces the incidence and recurrence of seizures.
• Depresses sub-cortical levels in CNS.

INDICATIONS

• Sedation for post resuscitation combativeness, combative head injury, intubations, pacing and cardioversion.
• Seizures, status epilepticus.

CONTRAINDICATIONS

• Pregnancy (relative contraindication), hypersensitivity to benzodiazepines, coma, acute narrow angle glaucoma, shock, alcohol intoxication.

PRECAUTIONS

• Hypotension, COPD, CHF, chronic renal failure, chills, elderly, debilitated.

DOSAGE

• INTUBATION: Initial dose, 2-5 mg IVP then 2-4 mg every 30 seconds to 1 minute.
• SEDATION, PACING, CARDIOVERSION: Initial dose 2-5 mg IVP then 2 mg every 30 second to 1 minute IVP. Max dose= 15 mg in the intubated patient. Can be given IM.07-.mg/kg with onset in approximately 15 minutes
• An IM injection requires immediate IV access upon sedation.
• HYPOTENSION responds well to Trendelenburg.
• Pediatrics refer to Handtevy System.

Ziprasidone (GEODON) / Antipsychotic

DESCRIPTION

• An atypical antipsychotic acting as a dopamine antagonist that also affects other neurotransmitters to reduce psychosis and acute agitation.

INDICATIONS

• Used for the control of acute agitation in schizophrenic and/or severely agitated patients.

CONTRAINDICATIONS

• Persons known to have prolonged QTc intervals
  • Only in high doses of 40-60 mg has shown a slight increase in QTc
• Known recent acute myocardial infarction
• Uncompensated heart failure
• Patients known to take other medications that also prolong the QTc interval
• Hypersensitivity to the medication.

PRECAUTIONS

• No clinically significant drug-drug interactions have been identified with other concomitantly administered EMS medications such as benzodiazepines.

DOSAGE

• 10 - 20 IM for adults based on the BARS scale for agitation.
• Not approved for use in pediatric patients.

ONSET OF ACTION

• Less than 15 minutes
• Peak effect 20-30 minutes
• Half-Life 2-5 hours

Behavioral Activity Rating Scale

7	Violent, requires restraint.
6	Extremely/continually active; not requiring restraint.
5	Signs of overt (physical or verbal) activity; calms down with instruction.
4	Quiet and awake (normal activity level).
3	Drowsy, appears sedated.
2	Asleep, but responds normally to verbal or physical contact.
1	Difficult or unable to arouse.

Medications known to prolong the QTc (This table is not all inclusive)

Adderall	Droperidol	Procainamide
Amiodarone	Effexor	Propulsid
Anzemet	Elavil	Prozac
Avelox	Erythromycin	Seroquel
Betapace	Haldol	Tamoxifen
Cardene	Lozol	Zanaflex
Cerebyx	Mellaril	Zithromax
Detrol LA	Norpace	Zoloft