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    (IV) or V (PO) Spectrum: Many strains of Streptococci (Drug of choice for Group A Strep - universally PCN sensitive), minority of Staphylococci (most are resistant) and some Enterococcus, most oral anaerobes, Syphilis (universally PCN sensitive). Used for: Strep throat and other infections due to Group A Strep, Syphilis (for neurosyphilis or pregnant women, must desensitize to PCN), bacteremia/endocarditis due to PCN sensitive Streptococcus, Enterococcus, or Staph aureus ( (PO) Spectrum: some Gram positives (Strep, Enterococcus, Listeria) but NOT MSSA, and limited Gram negative coverage. Notable gram negative holes include Klebsiella, Moraxella, and SPICE A organisms. Used for: Upper respiratory infections, sinusitis, otitis media, cellulitis, Listeria infections, UTI’s, early Lyme disease (alternative to Doxycycline), and more. Used for: Drug of choice for MSSA infections (unless PCN sensitive, which is rare). Good choice for cellulitis, osteomyelitis, endocarditis, and bacteremia from MSSA. Usually combined with beta lactamase inhibitors (see below) which confers broader activity; however, beta-lactamase component does not add activity vs Pseudomonas (so if Pseudomonas is sensitive, could use Piperacillin alone). addition of beta lactamase inhibitor confers broader spectrum against common beta-lactamase producing organisms (such as MSSA, some gram negatives including H.influenza, Moraxella, and virtually all anaerobes). Indikasjoner | Dosering | Kontraindikasjoner | Forsiktighetsregler | Interaksjoner | Graviditet, amming og fertilitet | Bivirkninger | Overdosering / Forgiftning | Egenskaper | Pakninger, priser og refusjon og uro, inkl. Pasienten, og nødvendighet av videre behandling, bør vurderes regelmessig, spesielt ved symptomfrihet. behandlingsperiode være nødvendig, men da må ny vurdering av pasientens status gjøres av spesialist. Ved avhengighet vil brå seponering gi abstinenssymptomer. Denne effekten vil imidlertid være kortvarig med tanke på diazepams store distribusjonsvolum. eller dobbelsyn forekommer hovedsakelig i starten av behandlingen, men avtar vanligvis ved gjentatt bruk. Nervøse tilstander og muskelspasmer: Ved nervøse tilstander initialt små doser, økes gradvis etter behov. Abstinenssymptomer kan også opptre innenfor doseringsintervallene, spesielt ved høy dose, og ved bytte til et benzodiazepin med kortere virketid. Rebound-effekt: Kan forekomme ved seponering, og kan være fulgt av andre reaksjoner som humørforandringer, , søvnvansker og rastløshet. Pasienten bør informeres om mulighet for rebound-effekt, at behandlingen vil ha begrenset varighet og at dosen vil gradvis reduseres. Hukommelsestap: Kan gi anterograd , oftest flere timer etter inntak. I tilegg kan metabolismen fra diazepam til desmetyldiazepam hemmes, men siden metabolitten også er aktiv, er den klinisk betydningen av dette trolig svært begrenset. Gastrointestinale forstyrrelser, endret libido eller hudreaksjoner er sett i enkelte tilfeller. Hvis ikke bedring i løpet av 1 uke overveies annen terapi. Pasienter bør sikre at de får 7-8 timer uforstyrret søvn for å redusere denne risikoen. Transient syncope and ECG changes associated with the concurrent administration of clozapine and diazepam. N03A E01 - Klonazepam N05B A - Benzodiazepinderivater N05B A01 - Diazepam N05B A02 - Klordiazepoksid N05B A03 - Medazepam N05B A04 - Oksazepam N05B A05 - Kaliumklorazepat N05B A06 - Lorazepam N05B A07 - Adinazolam N05B A08 - Bromazepam N05B A09 - Klobazam N05B A10 - Ketazolam N05B A11 - Prazepam N05B A12 - Alprazolam N05B A13 - Halazepam N05B A14 - Pinazepam N05B A15 - Kamazepam N05B A16 - Nordazepam N05B A17 - Fludiazepam N05B A18 - Etylloflazepat N05B A19 - Etizolam N05B A21 - Klotiazepam N05B A22 - Kloksazolam N05B A23 - Tofisopam N05B A24 - Bentazepam N05B A56 - Lorazepam, kombinasjoner N05C D - Benzodiazepinderivater N05C D01 - Flurazepam N05C D02 - Nitrazepam N05C D03 - Flunitrazepam N05C D04 - Estazolam N05C D05 - Triazolam N05C D06 - Lormetazepam N05C D07 - Temazepam N05C D08 - Midazolam N05C D09 - Brotizolam N05C D10 - Kvazepam N05C D11 - Loprazolam N05C D12 - Doksefazepam N05C D13 - Cinolazepam N03A E01 - Klonazepam N05B A - Benzodiazepinderivater N05B A01 - Diazepam N05B A02 - Klordiazepoksid N05B A03 - Medazepam N05B A04 - Oksazepam N05B A05 - Kaliumklorazepat N05B A06 - Lorazepam N05B A07 - Adinazolam N05B A08 - Bromazepam N05B A09 - Klobazam N05B A10 - Ketazolam N05B A11 - Prazepam N05B A12 - Alprazolam N05B A13 - Halazepam N05B A14 - Pinazepam N05B A15 - Kamazepam N05B A16 - Nordazepam N05B A17 - Fludiazepam N05B A18 - Etylloflazepat N05B A19 - Etizolam N05B A21 - Klotiazepam N05B A22 - Kloksazolam N05B A23 - Tofisopam N05B A24 - Bentazepam N05B A56 - Lorazepam, kombinasjoner N05C D - Benzodiazepinderivater N05C D01 - Flurazepam N05C D02 - Nitrazepam N05C D03 - Flunitrazepam N05C D04 - Estazolam N05C D05 - Triazolam N05C D06 - Lormetazepam N05C D07 - Temazepam N05C D08 - Midazolam N05C D09 - Brotizolam N05C D10 - Kvazepam N05C D11 - Loprazolam N05C D12 - Doksefazepam N05C D13 - Cinolazepam A07D A02 - Opium N02A - Opioider N02A A - Opiumsalkaloider N02A A01 - Morfin N02A A02 - Opium N02A A03 - Hydromorfon N02A A04 - Nikomorfin N02A A05 - Oksykodon N02A A08 - Dihydrokodein N02A A10 - Papaveretum N02A A51 - Morfin, kombinasjoner N02A A53 - Hydromorfon og nalokson N02A A55 - Oksykodon og nalokson N02A A56 - Oksykodon og naltrekson N02A A58 - Dihydrokodein, kombinasjoner N02A A59 - Kodein, kombinasjoner ekskl. N03A E01 - Klonazepam N05B A - Benzodiazepinderivater N05B A01 - Diazepam N05B A02 - Klordiazepoksid N05B A03 - Medazepam N05B A04 - Oksazepam N05B A05 - Kaliumklorazepat N05B A06 - Lorazepam N05B A07 - Adinazolam N05B A08 - Bromazepam N05B A09 - Klobazam N05B A10 - Ketazolam N05B A11 - Prazepam N05B A12 - Alprazolam N05B A13 - Halazepam N05B A14 - Pinazepam N05B A15 - Kamazepam N05B A16 - Nordazepam N05B A17 - Fludiazepam N05B A18 - Etylloflazepat N05B A19 - Etizolam N05B A21 - Klotiazepam N05B A22 - Kloksazolam N05B A23 - Tofisopam N05B A24 - Bentazepam N05B A56 - Lorazepam, kombinasjoner N05C D - Benzodiazepinderivater N05C D01 - Flurazepam N05C D02 - Nitrazepam N05C D03 - Flunitrazepam N05C D04 - Estazolam N05C D05 - Triazolam N05C D06 - Lormetazepam N05C D07 - Temazepam N05C D08 - Midazolam N05C D09 - Brotizolam N05C D10 - Kvazepam N05C D11 - Loprazolam N05C D12 - Doksefazepam N05C D13 - Cinolazepam Kilder Arvidsson SB, Ekström-Jodal B, Martinell SAG et al. Allerede eksisterende depresjon kan avdekkes under behandling. Hvis pasienten er ved bevissthet bør oppkast fremprovoseres (innen 1 time). Risiko øker med dose og behandlingsvarighet og er større ved tidligere alkohol- eller legemiddelmisbruk. N03A E01 - Klonazepam N05B A - Benzodiazepinderivater N05B A01 - Diazepam N05B A02 - Klordiazepoksid N05B A03 - Medazepam N05B A04 - Oksazepam N05B A05 - Kaliumklorazepat N05B A06 - Lorazepam N05B A07 - Adinazolam N05B A08 - Bromazepam N05B A09 - Klobazam N05B A10 - Ketazolam N05B A11 - Prazepam N05B A12 - Alprazolam N05B A13 - Halazepam N05B A14 - Pinazepam N05B A15 - Kamazepam N05B A16 - Nordazepam N05B A17 - Fludiazepam N05B A18 - Etylloflazepat N05B A19 - Etizolam N05B A21 - Klotiazepam N05B A22 - Kloksazolam N05B A23 - Tofisopam N05B A24 - Bentazepam N05B A56 - Lorazepam, kombinasjoner N05C D - Benzodiazepinderivater N05C D01 - Flurazepam N05C D02 - Nitrazepam N05C D03 - Flunitrazepam N05C D04 - Estazolam N05C D05 - Triazolam N05C D06 - Lormetazepam N05C D07 - Temazepam N05C D08 - Midazolam N05C D09 - Brotizolam N05C D10 - Kvazepam N05C D11 - Loprazolam N05C D12 - Doksefazepam N05C D13 - Cinolazepam Klinisk konsekvensØkt konsentrasjon av diazepam (inntil en fordobling av konsentrasjonen av fritt (ikke-proteinbundet og dermed farmakologisk aktivt) diazepam) vist i en studie med enkeltdoser. Enkelte tilfeller av abstinenssymptomer hos barn er sett. Skal kun brukes hvis fordelen oppveier en mulig risiko. Opphør av interaksjoner ved seponering kan gi økt/redusert virkning av gjenværende legemidler.: Kan gi psykisk og fysisk avhengighet. Enkelte tilfeller av dysmorfi og nevrologisk dysfunksjon er sett som følge av høye doser under graviditet. Eldre og pasienter med nedsatt allmenntilstand: Dosen bør reduseres, og bør sjelden overskride 2 mg 2 ganger daglig. Norsk legemiddelhåndbok: Forslag til nedtrapping og seponering Interaksjonsanalyse av legemiddellisten anbefales før seponering. Antagonism of diazepam by aminophylline in healthy volunteers. Akkumuleres i fosteret, og kontinuerlig tilførsel i lengre tid kan gi hypotoni, åndedrettsbesvær, hypotermi, sløvhet, diebesvær («floppy infant syndrome») og uregelmessig hjerterytme hos den nyfødte. alvorlige spastiske tilstander 30-60 mg daglig ved stasjonær behandling. Eldre og pasienter med nedsatt allmenntilstand: Vanligvis 2 mg. Aminophylline inhibition of diazepam sedation: is adenosine blockade of GABA-receptors the mechanism? Data fra et begrenset antall gravide viste økt risiko for misdannelser som ganespalte og mental retardasjon.

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