A patient has been taking high doses of clorazepate [Tranxene] for several months for an anxiety disorder. The nurse assessing the patient observes that the patient is agitated, euphoric, and an-xious. What will the nurse do?
a. Double-check the chart to make sure the last dose was given.
b. Request an order for a longer-acting ben-zodiazepine.
c. Suspect a possible paradoxical reaction to the clorazepate.
d. Withhold the next dose until a drug level can be drawn.
C
Patients taking benzodiazepines for anxiety sometimes develop paradoxical responses to the drug, which include insomnia, excitation, euphoria, heightened anxiety, and rage. A missed dose would trigger withdrawal symptoms, which would include anxiety, insomnia, sweating, tremors, and dizziness. Because this is a paradoxical reaction to the drug, a longer-acting drug would make the symptoms worse. This is not caused by overdose, which would manifest as drowsiness, lethargy, and confusion, so a drug level is not warranted.
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