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ca-nursing: knowing the reversals and opposites of meds is IMPORTANT! I work with DTers every wee and I honestly have never given or even seen librium prescribed. Ativan for EVERYONE! And lactulose is a joke. I suppose it works to a certain degree on bringing down ammonia levels, but perhaps my patient’s ammonia levels are so off the charts that they’d need a truckload of lactulose to even make a dent in their level.