Generic Name Clonazepam

Trade Name Klonopin

Classification ANTICONVULSANT; BENZODIAZEPINE

Dose .25mg

Route Oral

Time/frequency Daily/Bedtime

Peak 1-2 hours

Onset 60 min.

Duration Up to 12 h in adults; 68 h in children.

Why is your patient getting this medication Anticonvulsant effects may be due to presynaptic inhibition Produces sedative effects in the CNS, probably by stimulating inhibitory GABA receptors. Muscle spasms, associated anxiety

Normal dosage range Adult: PO 1.5 mg/day in 3 divided doses, increased by 0.51 mg q3days until seizures are controlled or until intolerable adverse effects (max recommended dose: 20 mg/day) Child (younger than 10 y): PO 0.010.03 mg/kg/day (not to exceed 0.05 mg/kg/day) in 3 divided doses; may increase by 0.250.5 mg q3days until seizures are controlled or until intolerable adverse effects (max recommended dose: 0.2 mg/kg/day) For IV meds, compatibility with IV drips and/or solutions

N/A

Mechanism of action and indications (Why would this med be ordered) Benzodiazepine derivative with strong anticonvulsant activity that prevents seizures by potentiation of the effects of GABA, an inhibitory neurotransmitter. Suppresses the spread of seizure activity in the cortex, thalamus, and limbic regions of the brain.

Nursing Implications (what to focus on) Contraindications/warnings/interactions CONTRAINDICATIONS - Hypersensitivity to benzodiazepines; liver disease; acute narrow-angle glaucoma; pulmonary disease, COPD; coma or CNS depression; pregnancy (category D), lactation; children younger than 10 y. CAUTIOUS USE - Renal or hepatic disease; COPD; drugcontrolled open-angle glaucoma; bipolar disorder, preexisting depression; addiction-prone individuals; neuromuscular disease; mixed seizure disorders; children. Common side effects CV: Palpitations. GI: Dry mouth, sore gums, anorexia, coated tongue, increased salivation, increased appetite, nausea, constipation, diarrhea. Hematologic: Anemia, leukopenia, thrombocytopenia, eosinophilia. CNS: Drowsiness, sedation, ataxia, insomnia, aphonia, choreiform movements, coma, dysarthria, "glassy-eyed" appearance, headache, hemiparesis, hypotonia, slurred

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) Alcohol, antidepressants , antihistamines ,other benzodiazepines, and opioid analgesics concurrent use results in CNS depression

speech, tremor, vertigo, confusion, depression, hallucinations, aggressive behavior problems, hysteria, suicide attempt. Respiratory: Chest congestion, respiratory depression, rhinorrhea, dyspnea, hypersecretion in upper respiratory passages. Skin: Hirsutism, hair loss, skin rash, ankle and facial edema. Special Senses: Diplopia, nystagmus, abnormal eye movements. Urogenital: Increased libido, dysuria, enuresis, nocturia, urinary retention. Lab value alterations caused by medicine Clonazepam causes transient elevations of serum transaminase and alkaline phosphatase. Patients on prolonged therapy should have CBC and liver function test results evaluated periodically. May cause an in serum bilirubin, AST, and ALT Be sure to teach the patient the following about this medication Report loss of seizure control promptly. Anticonvulsant activity is often lost after 3 mo of therapy; dosage adjustment may reestablish efficacy. Do not abruptly discontinue this drug. Abrupt withdrawal can precipitate seizures. Other withdrawal symptoms include convulsion, tremor, abdominal and muscle cramps, vomiting, sweating. Do not drive a car or engage in other activities requiring mental alertness and physical coordination until reaction to the drug is known. Drowsiness occurs in approximately 50% of patients. Evaluation Check after giving Monitor for signs of suicidal ideation in depressive individuals. Lab tests: Periodic liver function tests, platelet counts, blood counts, and renal function tests. Both psychological and physical dependence may occur in the patient on long-term, high-dose therapy. Monitor for S&S of overdose, including somnolence, confusion, irritability, sweating, muscle and abdominal cramps, diminished reflexes, coma.

Nursing Process- Assessment (Pre-administration assessment) Assess degree of anxiety and mental status before and throughout therapy. Assess for drowsiness, clumsiness, and unsteadiness as these are common during initial doses of therapy.

Assessment Why would you hold or not give this med? Unwanted side effects.