Article-benzodiazepine in elderly Flashcards
There is high-quality evidence In which age group does bento have potential cognitive adverse effect?
65 years of age or older.
Benzo use in elderly is associated with what?
cognitive decline, dementia and Alzheimer’s disease.
How would you describe the evidence regarding the correlation b/w Benz and dementia
conflicting
What kind of use of benzodiazepines have stronger links to cognitive decline?
Longer acting rather than shorter acting; longer rather than shorter durations of use; earlier rather than later exposure
what are benzodiazepines prescribed for?
anxiolytics, sedative; hypnotics; anticonvulsant ; skeletal muscle relaxant; adjunctive therapy for mint of psychological conditions
What does benzodiazepines MOA appear to be?
facilitated through inhibitory NT GABA (gamma-aminobutyric acid)
benzodiazepines site of action
limbic, thalamic and hypothalamic regions of CNS
what are short and intermediate-acting benzodiazepines prescribed for?
insomnia
what are long term benzodiazepines prescribed for?
anxiety
Major CNS undesirable effects from benzodiazepines
ataxia, fatigue, confusion, weakness, vertigo, dizziness and syncope
why does benzodiazepines half life extended in geriatric patients?
Due to age related changes in PK, PD, including alteration in drug distribution and elimination
What has long term use associated with?
increased risk of fall, dependence, withdraw, cognitive impairment
Percentage of US geriatric population received a least 1 benzodiazepines in 2008
9%, 1/3 being for long term use.
Gender difference in being prescribed
Women twice as likely.
What age range is the highest prevalence getting benzodiazepines
65-84
What does AGS currently recommend?
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.
If pt has to take it, then reduce the use of other CNS-active meds including
anticonvulsants, opioids, hypnotics, sedatives
What are long term benzodiazepines appropriate for?
seizure control, alcohol or benzo withdraw, severe anxiety, REM disorders and periprocedural anesthesia
Are shorter acting ones safer than longer acting ones?
Not in geriatric patients.
The NIH has commented on what increased of
residual daytime sedation, cognitive impairment, motor incoordination, dependence and rebound insomnia
What CNS effect of benzodiazepines is well known
acute cognitive and memory deficit
What CNS effect of benzodiazepine is less well understood
long term effect on CNS
What does more recent study suggest?
benzodiazepine use is associated with Alzheimer’s disease.
What did Caerphilly Prospective study (CaPS)reveal
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
What did they found with elderly population with normal baseline cognition?
The decline was not statistically significant
What does Three City study say?
Chronic benzodiazepine users had significantly poorer cognitive performance using many standardized neuropsychological tests.
What does Paterniti research find
Chronic users had a significantly higher risk of decline than both episodic and recurrent users.
How are study results of relationship between benzodiazepines and Alzheimer’s disease?
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.
Why MMSE may have diminished the reliability of measuring cognitive function in geriatric patients?
MMSE is primarily used in non acutely ill patients. In geriatric patients, many of them are acutely ill.
How does frequency affect benzodiazepine use and dementia
For every 20 daily doses of benzodiazepines use per year, dementia rate increases by 22%
What did Paterniti and Mura conclude
Long term use has increased risk for cognitive decline
Wha did Billioti de Gage conclude?
As the # of lifetime doses increases, the risk of Alzheimer’s disease increases as well.
What did Lagnaoui and Gallacher conclude?
The earlier the exposure, the greater the association with dementia.
What does reverse causation mean?
An association arises from treating the early symptoms of dementia prior to a known diagnosis.VS benzodiazepine is indeed responsible for causing the dementia.
In the EMPOWER study, % of users d/c benzodiazepines
after education?
27%, 5% in the control group
What is Beers criteria
inappropriate medication use
What is on Beers criteria
benzodiazepine, benzodiazepine receptor agonist, tricyclic antidepressant, antihistamine
Which ones not on Beers’ criteria but still active in CNS
trazodone , ramelteon
On which stages do sleeping agents increase sleep time?
Stage 1 and 2, overall increase by only 15 min
