Benzo's Flashcards
When does anxiety occur?
reaction when people are facing tough situations
If anxiety occurs frequently it can
decrease the quality of life
Non pharmacological treatments for anxiety (3)
- psychotherapy
- cognitive therapy
- supportive thereapies
what can we use for anxiety? drugs (6)
-Benzodiazepines
-antidepressants
other:
- antihistamine (sedative effect)
-neuroleptics
-B-blockers
-anticonvulsants
What is the mechanism of action for benzo’s?
-increase sensitivity of the GABA receptors in SNC
Benzodiazepines are the drug of choice for: (2)
insomnia and anxiety
Side effects of benzo’s (5)
- Sleepiness, stupor, coma.
- Decrease in alertness and attention.
- Disorientation, ataxia and agitation. (careful in elderly >60)
- Dependence(>6months) and withdrawal syndrome
- Respiratory center depression.
What is flumazenil? what route of administration do we use?
benzo’s antidote
IV
What is the antidote for benzos and how do they work? what route of administration do we use?
- block gaba receptors
- flumazenil
- IV
When does disorientation, ataxia and agitation with benzo’s occur? (4)
- Uncommon.
- In elderly.
- People> 60 year old are advised to start with half of the adult dose.
- Manifestations of the CNS depressant effect.
When does anterograde amnesia occur with benzos? (2)
- Medium to high doses.
- The memory process is altered.
Define hypnosis
induction of a state of sleep artificially by the action of various drugs
Define hypnotics
drugs used in the treatment of insomnia and produce a “similar” pattern of sleep.
Define normal sleep
a succession of phases of slow sleep or non- REM and REM sleep or rapid sleep of about 100 minutes
What drugs treat insomnia (2)
- drugs used as hypnotics
- the benzodiazepines (BZD) (-zepam or -zolam)
Subjective feelings of restlessness, uncertainty, and fear without apparent cause is called….
anxiety
Physical symptoms that accompany anxiety are… (5)
- sweating
- tremor
- tachycardia
- chest pain
- shortness of breath
What is the mechanism behind anxiety
hyperactivity of sympathetic nervous system w/ circulating catecholamines
THE ONLY ANXIOLYTICS (SPECIFICALLY FOR ANXIETY DISORDERS) USED NOWADAYS ARE
benzodiazepines
Benzodiazepines are what drug class?
anxiolytics
What does GABA stand for?
γ-aminobutyric acid (gamma)
GABA produces…
central inhibition
Benxiodiazapines have the effects of these drugs…(4)
- anxiolytics
- anticonvulsivants
- hypnotics
- muscle relaxants
*the predominance of these effects depends on the drug type
Benzo’s are classified according to… (5) What are the 4 types?
duration of action:
- ultra short action (half-life <5hrs)
- short action (half-life ~12hrs)
- intermediate (half-life ~24hrs)
- long action (half-life >24hrs)
What is the ultrashort action benzo?
midazolam
What are the short action benzos? (2)
- lorazepam
- alprazolam
What are the intermediate action benzos? (2)
flurazepam
bromazepam
What is the long short action benzo?
diazepam
benzo’s have excellent ____ absorption
oral
benzo’s have ____ bioavailability
high
how do benzo’s behave intramuscularly
erractic and slow absorption
How do benzo’s behave intravenously?
better than IM
can benzo’s be given rectally?
yes
benzos have ____ protein binding
high
How are benzo’s metabolized?
- hepatic
- active metabolites
Are benzo’s excreted easily?
yes
Benzo indications? (6)
- anesthesia
- insomnia
- anxiety
- epilepsy
- alcohol withdrawal
- muscular relaxation
What bezno is used for anesthesia and why? (4)
Midazolam (IV)
- ultrashort action
- induction and maintenance of anesthesia
What bezno is used for insomnia and why? (9)
- short action or intermediate action (P.O.)
- induce sleep + calming effect
- lorazepam
- lormetazepam
- hypnotic and sedative
What bezno is used for anxiety and why? (2)
- long action (P.O)
- reduce / eliminate anxiety
What bezno is used for alcohol withdrawl and why? (2)
- long action (P.o)
- diazepam (in delitium tremens)
What bezno is used for muscular relaxation and why? (5)
- useful for spasms (contractions) and torticollis (stiff neck)
- tetrazepam (now discontinued)
- low doses of diazepam
- makes the pateint drowsy
whats toticollis?
stiff neck
Which benzo was used as a muscle relaxant but is now discontinued?
tetrazepam
What are the drug interactions with benzos? why?(6)
- CNS depressive effect is greater
- alcohol
- barbiturates
- opiates
- can result in hypoventillation and coma
Benzo contraindications? (4)
-myasthenia gravis Cautioned with: -chronic respiratory disease (COPD) -liver disease -pregnancy/breastfeeding
Benzos are dangerous when…. (3)
- adminsitered IV at high doses
- with other CNS depressants (ex. opiates)
- (cautioned)with chronic respiratory disease
somnolence, stupor and coma with benzos… (3)
- side effect in elderly
- can improve in a few days
- worse if another CNS depressant is ingested
What drug can be taken in high doses with the intention to commit suicide? what are the effect? (3)
benzodiazepines
- hypoventilation
- coma
What is ataxia
lack of voluntary coordination of muscle movements
When does addiction occur with benzos?
6 months
When does benzo withdrawl occur? (2)
- using longer than 6 months
- when stopping treatment
Which drugs cause bezno withdrawl?
medium-short half life
What are benzo withdrawl symptoms? (8)
Mild: insomnia and anxiety Sometimes: -irritability -sweating -tremor -muscle stiffness -seizures -psychosis
How do we prevent benzo addiction? (3)
- lowest dose
- shortest time (no more than 4-6 months)
- dont stop treatment abruptly (reduce over 2 weeks)
can benzos be used during pregnancy and/or pregnancy?
no
What are the anxiolytic drugs?
- benzos
- buspirone
What effect does buspirone have?
sedative
hypnotic
When is buspirone the 1st choice of treatment? (3)
when benzodiazpine:
- is contraindicated
- has too many adverse effects
- no addiction
Why is buspirone the 2nd choice of treatment? (2)
because benzo’s are:
- faster
- stronger
Which drugs are hypnotics? (5)
- Barbiturates (not used as hypnotics anymore)
- Benzodiazepines.
- Chlormethiazole: hypnotic, sedative, anticonvulsant.
- Doxilamine (antihistamine H1)
Hypnotic, sedative, muscle relaxant, anticonvulsant:
- Zolpidem
- Zopiclone
The group of drugs most commonly used as HYPNOTICS are
BENZODIAZEPINES (BZD)
-zepam or zolam
