JB is a 12 year old boy (23kg) recently diagnosed with seizures. JB has a PMH of seasonal allergies. He was recently initiated on oxcarbazepine to be titrated up to a maintenance dose of 300mg BID. In case of breakthrough seizures at home while titrating up his dose, his physician wrote for a prescription of Diastat 5mg. Select all of the following that are true related to the dispensing of Diastat.
A. The pharmacist should remove Diastat from the casing and set and lock the dosage to 5mg before dispensing to the patient
B. Diastat must be stored in the refrigerator until used
C. Diastat should be used for seizures that are different from the patient’s ordinary seizure activity
D. All remaining medication in the syringe should be discarded after administration
E. JB should be placed flat on his stomach while the medication is administered
Diastat (diazepam) is a commonly dispensed benzodiazepine used in the management of seizures.
Answer A is correct as pharmacists MUST lock the syringe with the correct dose prior to dispensing the medication. Diastat comes in 10mg and 20mg syringes which can deliver minimum dosages of 5mg and 12.5mg respectively in increments of 2.5mg. The pharmacist must lock the dose even if the prescription was written for the max dose available in the syringe.
Answer B is incorrect because Diastat should be stored at room temperature between 59 and 86 degrees Fahrenheit.
Answer C is correct as Diastat is not recommended for chronic, daily use because of the potential of tolerance. Chronic daily use can increase the frequency and/or severity of tonic clonic seizures. Patients and prescribers must be properly trained to determine when it is appropriate to administer Diastat.
Answer D is correct. While there will likely be medication remaining in the syringe, the remaining medication should be properly disposed of after single use in a sink or toilet. The actual plunger can then be placed in the trashcan away from children.
Answer E is incorrect because patients receiving Diastat should be placed on their side with their upper leg forward to expose the rectum rather than on their back.
Big thanks to my UGA academia student Summer Sizemore for her help in composing the Question of the Week!