# diazepam vs lorazepam vs alprazolam



## coolidge (Sep 23, 2008)

What are the benefits of carrying one of these drugs over the other?


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## Flight-LP (Sep 23, 2008)

Diazepam is time proven and is still the workhorse of the EMS benzo family. Its cheap, effective, and readily available. But it also has the longest half life of the three and needs to be closely monitored.

Lorazepam is deemed by some to be more effective for seizure activity, but has to be refridgerated to remain effective. Again, cheap and readily available but unless you have a cooler on the truck, its not going to last.

Alprazolam is only seen on the trucks when medics are prescribed it! You will not see Xanax in too many protocols as it is PO only. Not for use in an emergency situation and not beneficial for seizure activity.

My personal favorite is Versed. Multiple uses and easy to titrate. Plus it is great for conscious sedation.


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## mycrofft (Sep 23, 2008)

*Speed of action and duraton of effect..Vent? Ridryder? Et al?*

Good opportunity to look studious to your medical director, ask her/him!


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## Flight-LP (Sep 24, 2008)

Where did my previous response go????????

Sorry man, tried to answer you, but my post seems to have disappeared......hmmmm


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## Guardian (Sep 24, 2008)

coolidge said:


> What are the benefits of carrying one of these drugs over the other?




It depends on what you're trying to accomplish.  Are you using the medication as induction agent?  Are you trying to control a seizure?  Are you trying to control status epilipticus?  Are you giving it to control anxiety?  It all depends.  


In addition to what Flight LP wrote, Midazolam (versed) is stronger and thus should be given when no IV access is available.  Diazepam (valium) is always a good compromise when you can only carry one medication.  It's longer lasting and better for status epilipticus.  Normally you wouldn't use Lorazepam as an induction agent, unless you had a long transport and needed a long acting medication.  Valium is arguably better than versed with drunks, people with glaucoma, and decreased LOC but not necessarily better for use in people with decreased BP.

The best advice is to learn how the individual drugs work differently on the central nervous system and then use that information with your patient's variables to come up with the best treatment plan possible.  They all have advantages and disadvantages.


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## Ridryder911 (Sep 24, 2008)

Versed is one of the best anticonvulsant medications out there. The actions of the medications is the best for stopping the seizure activity but alike any other medications it has dangers as well, such as causing respiratory depression. The other advantage I like about it is it can be given nasally per atomizer. I routinely do this, as to stop the seizure activity then establish my lifeline, and perform a better diagnostic assessment. 

Ativan is a great med too, but as Flight described one of the disadvantages it must be refrigerated. There is a non-refrigerated form but costly and has to be constituted before administering. 

Xanax is not a prehospital medication and as well is one of the most abused prescriptive medications today. Alike the days of Valium in the 60's, today's med is Xanax for the over misdiagnosed "anxiety". I personally believe very little truly have anxiety attacks, but rather poor coping mechanisms of daily life pressures. 

Valium is the good old stand by, but the duration is so long before an accurate neuro exam can be performed. Remember, it does NOT stop the seizures but rather relaxes muscles. It is a good medications for active seizures as well. Again, it has other routes than just IV too. 
R/r 911


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## mycrofft (Sep 24, 2008)

*Valium and Ativan in ETOH detox*

Now that the pertinent information is already in...
We used PO and IM Ativan for ETOH detox. Fast in, fast out, rollercoastering. We switched to PO Valium and had much better control. I don't know if Valium's ineffective in stopping seizures, but it did a darn good job preventing them...except when the liver was vershtunkiner. Then it piled up if you were inattentive to the total dose, and when the liver woke up from its drunken stupor...."Houston, we have acheived sedation".


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## pumper12fireman (Sep 24, 2008)

Ridryder911 said:


> Xanax is not a prehospital medication and as well is one of the most abused prescriptive medications today. Alike the days of Valium in the 60's, today's med is Xanax for the over misdiagnosed "anxiety". I personally believe very little truly have anxiety attacks, but rather poor coping mechanisms of daily life pressures.
> 
> R/r 911



I couldn't agree with this more. You should see, and I'm sure many of you have the way a pt.'s eyes light up when you see the doc give them a prescription for Xanax...


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## mycrofft (Sep 24, 2008)

*Here's a shocker: even if the pt abuses it, a given med may be the appropriate one.*

but Xanax...not so much, as they say.
Be that as it may, witholding an appropriate treatment because someone is allegedly an abuser, or because you or I have seen hundreds of abusers of that particular drug, is malpractice and maybe civilly liable as well.


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## Ridryder911 (Sep 25, 2008)

mycrofft said:


> but Xanax...not so much, as they say.
> Be that as it may, witholding an appropriate treatment because someone is allegedly an abuser, or because you or I have seen hundreds of abusers of that particular drug, is malpractice and maybe civilly liable as well.




As well as having "drug seeking behavior" or "Doc shopping" is a crime. Our state has a "tracker" if one receives a narcotic prescription from variable physicians or same med within a period of time. It is immediately reported to the Narcotic Bureau and the Pharmacist is not allowed to fill. 

R/r 911


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## mycrofft (Sep 25, 2008)

*Dang, tough state!*

We are forbidden to use the phrase "drug seeking behavior". I just include long quotes and describe the physical findings versus the complaints and note "c/o doesn't correspodn wi. s/s" or "hx self-contradictory", "labile historian" etc.


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## mikie (Sep 25, 2008)

I can (but do not support it!) understand people taking small doses of non-prescribed to themselves Xanax to 'comfort their anxiety.'  Other than OD purposes, what is the point of taking it in larger doses??

What are the doses people are abusing it?  How is it so easy to get?

I've had patients take 10+ pills mixed with alcohol (a BIG no-no, why is that?) and all I can say is WOW.  

I'll admit, I do have an Rx for it, small dose.  It was actually kinda funny, for FD applications around here, drug tests are required (not the funny part), so I made a copy of my Rx for it.  When I copied it, the original script the doc wrote, in the background it said ILLEGAL everywhere (tamper proof watermarks), whereas just looking at it, its just a cool blue texture.   So since it looks crazy like that, do I just bring the bottle to the application process?


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## Ridryder911 (Sep 25, 2008)

mikie333 said:


> I made a copy of my Rx for it.  When I copied it, the original script the doc wrote, in the background it said ILLEGAL everywhere (tamper proof watermarks), whereas just looking at it, its just a cool blue texture.   So since it looks crazy like that, do I just bring the bottle to the application process?



Why would you have a copy of your prescription? The pharmacist should have kept it for their records. I would bring a copy or list of medications from your pharmacist. This should meet the requirements or statements from your physician.

R/r 911


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## mikie (Sep 25, 2008)

Ridryder911 said:


> Why would you have a copy of your prescription? The pharmacist should have kept it for their records. I would bring a copy or list of medications from your pharmacist. This should meet the requirements or statements from your physician.
> 
> R/r 911



Before I filled it at Walgreens, I made a copy (knowing in advance it would pop up for my screening), wasn't sure what the dept would want.

If I just brought in a list, couldn't they question its authenticity?  Could I just bring in the bottle?

(post 500! )


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## Ridryder911 (Sep 25, 2008)

mikie333 said:


> If I just brought in a list, couldn't they question its authenticity?  Could I just bring in the bottle?
> (post 500! )



Yes, you could bring in the bottle (which most do not want to be responsible for handling and they have to fill in the information) or you can have your pharmacist make a list of your current prescribed medications (especially any that could be detected on a drug screen). This will contain the the physician, date filled, and order. If needed they can place that into the file and drug testing information. 


The reason not to make a copy of the prescription is just that...illegal. This was an old method that many would attempt to obtain illegal prescriptions. 

R/r 911


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## mikie (Sep 25, 2008)

Ridryder911 said:


> The reason not to make a copy of the prescription is just that...illegal. This was an old method that many would attempt to obtain illegal prescriptions.
> 
> R/r 911



Hence the watermark that was displayed.

I'm more curious to know why it's so abused and at what doses?  Furthermore, how is it so easily obtainable?


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## Ridryder911 (Sep 25, 2008)

It's abused because it an anti anxiety and it does not matter what the dosage, as far as availability, I am sure if you have the money $$ one can find it easily. 

R/r 911


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## KEVD18 (Sep 25, 2008)

its easily obtained because almost every gp will write just about anyone for it along as the phrase the request properly. 

then, the people that dont really need it fill the scrips and sell the pills every month. theres plenty of benzo's floating around on the street. you just have to know who to ask.


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## coolidge (Sep 27, 2008)

*experience*

What is the deciding factor you use to determine which drug is used?  What is the root cause of why ami vs lido was selected?


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## reaper (Sep 27, 2008)

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$


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## fma08 (Sep 27, 2008)

mikie333 said:


> Before I filled it at Walgreens, I made a copy (knowing in advance it would pop up for my screening), wasn't sure what the dept would want.
> 
> If I just brought in a list, couldn't they question its authenticity?  Could I just bring in the bottle?
> 
> (post 500! )




Not sure how it works at walgreen's, but for 3 years of high school I worked as a pharmacy tech. When people wanted a list of their medications for insurance or other purposes, there was an option in the computer program to print out a summary for each individual, on each summary it had the basic pt. info, medication list, and a spot for the pharmacist to sign for authenticity.


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## mikie (Sep 27, 2008)

i just copied the rx BEFORE i took it to walgreens...but w/e...back to the thread!  ^_^


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## coolidge (Sep 28, 2008)

Thanks Mr. Reaper.
I am a pharmacist and an EMT, and appreciate your comment


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## mycrofft (Sep 28, 2008)

*I remember when Valium was considered to be "safe as mother's milk".*

Late Seventies. Yee gads!.

To digress further, we see many inmates being booked with multiple legal Rx for narcotics, benzo's, even methadone, because in the modern prescribing world it is safer to prescribe than risk a complaint about failure to control pain, maybe civil suit. Narcs are cheap, insurance doesn't care. Plus they pass em around, Rx's as well as the actual drugs. Then we see benzo withdrawl...oh, but they are usually coming off crank as well. And ETOH. Oh, well, pass the Valium.


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## darbelis12 (Oct 6, 2010)

*Xanax*



pumper12fireman said:


> I couldn't agree with this more. You should see, and I'm sure many of you have the way a pt.'s eyes light up when you see the doc give them a prescription for Xanax...



Thats right.


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