Is Ativan 10 mg po per dose too much? - page 3

Last night a 49 year old male patient was admitted to our med surg unit with R/O PE which was later ruled out. He also had a history of anxiety. Admitting doctor ordered 5 to 10 mg Ativan po Q 4hrs... Read More

  1. by   Morning-glory
    Holy cow, what a mess. I would not have given 10 mg Ativan PO. In fact just last week I had a pt getting 2 mg po qid and he was stumbing around peeing in garbage cans and couldn't hit the toilet even when he was awake enough to try, and this guy had been a hard core drug abuser. Had it decreased and they added Olanzapine for the psychotic behaviour, which is working much better. Ativan is good for very short term anxiety, but there are better meds out there for the long term chronic anxiety patients.

    You done good. Ativan does really wierd things to people's brains. I had too many people go bonkers on it to make me comfortable giving more than 2 mgs at a time. Even then, I watch them like a hawk for 4 hours.
  2. by   steelcityrn
    So this guy can drive home on 5 mg of ativan, sure sounds like he needed 10 after all !! haha...But seriously, thats a high dose that we seldom see, and I would not want to give that either for fear of severe reaction.
  3. by   leslie :-D
    why is valium 10mg po acceptable but not ativan 10mg po?
    and valium has a longer half life..........just thinking aloud.
  4. by   JessRichards
    That would be to much for some one new to the benzo family of drugs but, they were detoxing him from his XanaX habit Dumby.
    You really do not need to play with life's.
  5. by   tridil2000
    Quote from JessRichards
    That would be to much for some one new to the benzo family of drugs but, they were detoxing him from his XanaX habit Dumby.
    You really do not need to play with life's.

    Dear lord, you administer meds and you write and spell like an 8 year old?

    In 23 years in ED I've never given more than 6 mg *IV* (2mgs at a time) over maybe an hour due to severe uncontrolled aggitation.

    Remember the little rule in school - if you find yourself opening more than 2 unit doses for something CHECK the order... something's wrong. Ativan po comes in 1mg unit doses, so you'd have to open 10! Red flag right there!!!

    Always be ready to tube someone when you use any kind of sedation. You NEVER know how people are going to react.
  6. by   systoly
    Didn't the order say "5 to 10mg Ativan PO"? That in itself shows it's a crappy order. As long as the doc chooses throwing a fit over providing a rationale, there'll be no mega dosing.
  7. by   foolme2x
    I can't even believe what I am reading. 10mg by mouth? When they have no tolerance? Sounds exactly like a valium mixup to me. You did the right thing. You have to question every order these days. They gave my father 5 mg of ativan in his line and put him in a medicinal coma for two weeks. You never know. Kudos to you!
  8. by   Meriwhen
    I agree: it seems like the doctor may have meant to write it for Valium, since that dosage range would fit diazepam perfectly.

    I've worked in detox and I've never given a patient more than 2mg of Ativan at a time max. I've had patients come in that have been using 6, 8, 10 and more mg of Ativan at a shot--among other drugs--but I've never doled that amount out to anyone. And if we are going to use a benzo to detox, it's either going to be Librium or Valium: nice long-acting benzos that will do the job right...we're certainly not giving him Ativan or Xanax.
  9. by   TriciaJ
    I love that she made you write an incident report. Now Risk Management gets to see how she prescribes.
  10. by   Perpetual Student
    Got Romazicon?
  11. by   shortd
    Holy jeez! How about just writing an order to take a 2x4 to pt's head? Call the doc, question to see if was a typo, then make an SBAR note of the exact conversation and make a copy of the order. I'd be more party to it if he was intubated and on HR, RR, o2 sat, and bp monitoring. Have flumazenil at bedside.

    Week ago I had an etoh DT pt with an order to start an ativan gtt at 4mg/hr. I liked that order because of past experiences with DT pts but I titrated starting with 2mg/hr because he settled down when I decreased some of the restraints, turned off the lights, and began talking to him about his work, family, etc. During report night shift and I decided to go to 4mg/hr just so we wouldn't have any more outbursts and it was a specific order. Literature is saying now to try other meds since benzos can give frightening hallucinations, cause hypoactive delirium or paradoxical effect.

    Other side, we transferred a pt to med/surg only to be returned the next day because the nurse did not give his scheduled ativan, a pt addicted to benzos and a history of d/c'ing 7 piccs, his wound vac over an appox 6x10 abdominal incision, and a t-tube drain during anxiety episodes. She charted she gave it but told the doc she didn't give it. Whoa, go back and re-chart before you admit you falsified a pt's medical record.

    Sad story, he went back to the floor without a med/tele box even with a HX of recent cardiac events and coded, has an anoxic injury, GCS of 8 now.