Page 165 - 2022 Ranger Medic Handbook

DIAZEPAM (VALIUM) – CONTROLLED MEDICATION IV
Class: CNS agent – benzodiazepine; anticonvulsant; anxiolytic
Action: Anticonvulsant and antianxiety psychotherapeutic drug with action at both limbic and subcortical levels of
CNS; increases total sleep time, but shortens REM and stage 4 sleep
Dose: 5–10mg slow IV push, repeat in 3–4hr; 2–10mg PO tid–qid
Onset/Peak/Duration: Onset/Peak/Duration 2–4 hours
Indications: For anxiety, seizures, skeletal muscle spasm relief; also used as an amnesic, for treatment of restless leg
syndrome, acute alcohol withdrawal, and is the drug of choice for status epilepticus
Contraindications: Shock, coma, alcohol intoxication, depressed vital signs; acute narrow-angle glaucoma, untreated
open-angle glaucoma; MAOIs; pregnancy category consider alternative during pregnancy and while breastfeeding
Adverse/Side-effects: Throat and chest pain; drowsiness, fatigue, ataxia, confusion, paradoxical rage, dizziness,
vertigo, amnesia, vivid dreams, headache, slurred speech, tremor; EEG changes, tardive dyskinesia; hypotension,
tachycardia, edema, cardiovascular collapse; blurred vision, diplopia, nystagmus; xerostomia, nausea, constipation,
hepatic dysfunction; incontinence, urinary retention, gynecomastia (prolonged use); hiccups, coughing, laryngo-
spasm; venous thrombosis, phlebitis
Interactions: Alcohol, CNS depressants, anticonvulsants, and herbals potentiate CNS depression; cimetidine in-
creases levels and toxicity; may decrease effects of levodopa; may increase phenytoin levels; smoking decreases SECTION 4
sedative and antianxiety effects
Mission Impact: Drowsiness. GROUNDING medication for personnel on flight status.
K9 Dosage: For seizures, 15–30mg (0.5–1mg/kg) IV or 30–60mg (1–2mg/kg) rectally q4hr. For sedation combined with
opioid, 7.5mg (0.25mg/kg) IV/IM q4hr

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DIPHENHYDRAMINE (BENADRYL)
Class: ENT agent – H 1 -blocker; antihistamine
Action: H1-receptor antagonist and antihistamine as it competes for H 1 -receptor sites on effector cells; significant
central anticholinergic activity as it prolongs action of dopamine by inhibiting its uptake and storage, thus decreasing
Parkinsonism and drug-induced extrapyramidal symptoms
Dose: 25–50mg IV/IM/PO q4–6hr
Onset/Peak/Duration:
IV – Onset immediate/Peak in 1–3 hours/Duration 6–8 hours
IM – Onset 30 minutes/Peak 1–3 hours/Duration 6–8 hours
PO – Onset 15–60 minutes/Peak in 1–3 hours/Duration 6–8 hours
Indications: For allergic conditions; treatment or prevention of motion sickness or vertigo; blood or plasma reactions;
treatment of Parkinsonism and drug-induced extrapyramidal reactions; also used with epinephrine for anaphylaxis;
may be used as a cough suppressant, a sedative-hypnotic or for intractable insomnia
Contraindications: Antihistamine hypersensitivity, lower respiratory tract symptoms, asthma; narrow-angle glaucoma,
prostatic hypertrophy, bladder neck obstruction, GI obstruction, pregnancy category may use during pregnancy and
consider alternative while breastfeedings
Adverse/Side-effects: Drowsiness, dizziness, headache, fatigue, disturbed coordination, tingling, heaviness and
weakness of hands, tremors, euphoria, nervousness, restlessness, insomnia, confusion, excitement, fever, palpita-
tion, tachycardia, hypo- or hypertension, cardiovascular collapse, tinnitus, vertigo, dry nose/mouth, nasal stuffiness,
blurred vision, diplopia, photosensitivity, dry eyes, nausea, epigastric distress, anorexia, vomiting, constipation, diar-
rhea, urinary frequency or retention, dysuria, thickened bronchial secretions, wheezing, chest tightness
Interactions: Alcohol, other CNS depressants, and MAOIs compound CNS depression
Mission Impact: GROUNDING, Sedative effects on patient should be considered in tactical situation
K9 Dosage: 50mg IM/SQ/PO. Impacts sense of smell

2022 RANGER MEDIC HANDBOOK 151