Which of the following should be included in the health teachings among clients receiving Valium:
A. Avoid taking CNS depressants like alcohol.
B. There are no restrictions in activities.
C. Limit fluid intake.
D. Any beverage like coffee may be taken.
Correct Answer: A. Avoid taking CNS depressants like alcohol.
Valium is a CNS depressant. Taking it with other CNS depressants like alcohol; potentiates its effect. The toxic-to-therapeutic ratio of benzodiazepines is very high, making them relatively safe medications. However, the potential of overdose from diverted diazepam always exists when combined with opioids, alcohol, or other centrally acting agents. Overdose in adults frequently involves the co-ingestion of other CNS depressants, which work synergistically to increase toxicity.
Option B: The client should be taught to avoid activities that require alertness. In mild cases, lethargy, drowsiness, and confusion are common symptoms. In cases of severe overdose, symptoms manifest as ataxia, diminished reflexes, hypotonia, hypotension, respiratory depression, coma (rarely), and death (very rarely).
Option C: Valium causes dry mouth so the client must increase her fluid intake. It is crucial to monitor respiratory and cardiovascular status, blood pressure, heart rate, and symptoms of anxiety in patients taking diazepam. With long-term use, monitor liver enzymes, CBC, and for signs of propylene glycol toxicity, including serum creatinine, BUN, serum lactate, and osmolality gap. With critically ill patients, monitor the depth of sedation.
Option D: Stimulants must not be taken by the client because it can decrease the effect of Valium. Potent inhibition of the 2C19 enzyme by certain drugs (fluoxetine and chloramphenicol) and 3A4 enzymes by certain medications (ketoconazole, protease inhibitors, erythromycin) may cause increased levels of diazepam, while inducers of 2C19 (rifampicin and prednisone) and 3A4 (carbamazepine, topiramate, phenytoin, St. John’s wort, rifampin, or barbiturates) may cause lower levels. Metabolites of diazepam are conjugated with glucuronide and excreted almost entirely in the urine.