Article-benzodiazepine in elderly

Question 1

There is high-quality evidence In which age group does bento have potential cognitive adverse effect?

Answer 1

65 years of age or older.

Question 2

Benzo use in elderly is associated with what?

Answer 2

cognitive decline, dementia and Alzheimer’s disease.

Question 3

How would you describe the evidence regarding the correlation b/w Benz and dementia

Answer 3

conflicting

Question 4

What kind of use of benzodiazepines have stronger links to cognitive decline?

Answer 4

Longer acting rather than shorter acting; longer rather than shorter durations of use; earlier rather than later exposure

Question 5

what are benzodiazepines prescribed for?

Answer 5

anxiolytics, sedative; hypnotics; anticonvulsant ; skeletal muscle relaxant; adjunctive therapy for mint of psychological conditions

Question 6

What does benzodiazepines MOA appear to be?

Answer 6

facilitated through inhibitory NT GABA (gamma-aminobutyric acid)

Question 7

benzodiazepines site of action

Answer 7

limbic, thalamic and hypothalamic regions of CNS

Question 8

what are short and intermediate-acting benzodiazepines prescribed for?

Answer 8

insomnia

Question 9

what are long term benzodiazepines prescribed for?

Answer 9

anxiety

Question 10

Major CNS undesirable effects from benzodiazepines

Answer 10

ataxia, fatigue, confusion, weakness, vertigo, dizziness and syncope

Question 11

why does benzodiazepines half life extended in geriatric patients?

Answer 11

Due to age related changes in PK, PD, including alteration in drug distribution and elimination

Question 12

What has long term use associated with?

Answer 12

increased risk of fall, dependence, withdraw, cognitive impairment

Question 13

Percentage of US geriatric population received a least 1 benzodiazepines in 2008

Answer 13

9%, 1/3 being for long term use.

Question 14

Gender difference in being prescribed

Answer 14

Women twice as likely.

Question 15

What age range is the highest prevalence getting benzodiazepines

Answer 15

65-84

Question 16

What does AGS currently recommend?

Answer 16

avoid all benzodiazepine in most adults 65 years of age or older. Should also be avoided in elderly with dementia, delirium or cognitive impairment d/t worsening of cognitive impairment, delirium falls, fractures and motor vehicle accidents.

Question 17

If pt has to take it, then reduce the use of other CNS-active meds including

Answer 17

anticonvulsants, opioids, hypnotics, sedatives

Question 18

What are long term benzodiazepines appropriate for?

Answer 18

seizure control, alcohol or benzo withdraw, severe anxiety, REM disorders and periprocedural anesthesia

Question 19

Are shorter acting ones safer than longer acting ones?

Answer 19

Not in geriatric patients.

Question 20

The NIH has commented on what increased of

Answer 20

residual daytime sedation, cognitive impairment, motor incoordination, dependence and rebound insomnia

Question 21

What CNS effect of benzodiazepines is well known

Answer 21

acute cognitive and memory deficit

Question 22

What CNS effect of benzodiazepine is less well understood

Answer 22

long term effect on CNS

Question 23

What does more recent study suggest?

Answer 23

benzodiazepine use is associated with Alzheimer’s disease.

Question 24

What did Caerphilly Prospective study (CaPS)reveal

Answer 24

Men who had taken benzodiazepines regularly at 1 or more times in their lifetime had a significant increased frequency of dementia, with stronger correlation seen in patients with earlier initial exposure

Question 25

What did they found with elderly population with normal baseline cognition?

Answer 25

The decline was not statistically significant

Question 26

What does Three City study say?

Answer 26

Chronic benzodiazepine users had significantly poorer cognitive performance using many standardized neuropsychological tests.

Question 27

What does Paterniti research find

Answer 27

Chronic users had a significantly higher risk of decline than both episodic and recurrent users.

Question 28

How are study results of relationship between benzodiazepines and Alzheimer’s disease?

Answer 28

Two such studies have conflicting results. In a retrospective case-control analysis, starting less than 3 years prior to dx was not associated with increased risk of developing Alzheimer. But 10-year , case-control study by Billioti deGage, found that association stronger for long acting than short acting.

Question 29

Why MMSE may have diminished the reliability of measuring cognitive function in geriatric patients?

Answer 29

MMSE is primarily used in non acutely ill patients. In geriatric patients, many of them are acutely ill.

Question 30

How does frequency affect benzodiazepine use and dementia

Answer 30

For every 20 daily doses of benzodiazepines use per year, dementia rate increases by 22%

Question 31

What did Paterniti and Mura conclude

Answer 31

Long term use has increased risk for cognitive decline

Question 32

Wha did Billioti de Gage conclude?

Answer 32

As the # of lifetime doses increases, the risk of Alzheimer’s disease increases as well.

Question 33

What did Lagnaoui and Gallacher conclude?

Answer 33

The earlier the exposure, the greater the association with dementia.

Question 34

What does reverse causation mean?

Answer 34

An association arises from treating the early symptoms of dementia prior to a known diagnosis.VS benzodiazepine is indeed responsible for causing the dementia.

Question 35

In the EMPOWER study, % of users d/c benzodiazepines

after education?

Answer 35

27%, 5% in the control group

Question 36

What is Beers criteria

Answer 36

inappropriate medication use

Question 37

What is on Beers criteria

Answer 37

benzodiazepine, benzodiazepine receptor agonist, tricyclic antidepressant, antihistamine

Question 38

Which ones not on Beers’ criteria but still active in CNS

Answer 38

trazodone , ramelteon

Question 39

On which stages do sleeping agents increase sleep time?

Answer 39

Stage 1 and 2, overall increase by only 15 min