Benzodiazepines Flashcards
Indications
- 1st line for seizures and alcohol withdrawal
- short term for anxiety/disorders, insomnia, spastic/involuntary movements, surgery interventions
Drugs
Pams and Lams
alprazolam
clonazepam
diazepam
lorazepam
Addiction to Benzos and Withdrawal
- dependence develops with regular use
- withdrawal symptoms with abrupt stoppage > REDUCE SLOWLY
S/S Benzo Withdrawal
Tremors Anxiety Dysphoria Perceptual Disturbances Potentially Serious - Delirium - Seizures - Autonomic hyperactivity
Benzos Physiologically Addictive
- DANGEROUS WITHDRAWAL
- MUST TAPER OFF
» Progress very slowly
» Must be monitored
Kinetics of Benzos ***
Short Half Life < 12 hrs - (ATM)
- Alprazolam
- Triazolam
- Midazolam
- Used for insomnia bc shorter half life **
- Usually abuse (especially alprazolam + lorazepam **
Intermittent Half Life 12-24 hrs - (TLC)
- Temazepam
- Lorazepam
- Clonazepam
Long Half Life > 24 hrs - (CDC)
- Chlordiazepoxide
- Diazepam
- Clorazepate
- Used for anxiety **
- Greater risk of accumulating in elder 2/2 long HL **
- Reduced rebound effect **
- Reduced withdrawal symptoms **
Benzo Contraindications and Precautions
Contraindications:
- Acute or Chronic Narrow Angle Glaucoma
Precautions:
- Compromised renal, hepatic, pulm systems
»_space; May cause hepatic encephalopathy with liver
cirrhosis
»_space; Depresses respirations
»_space; Metabolized by Liver
»_space; Excreted by Kidneys
- History of substance abuse
- CNS depressants including alcohol and opioids
- Elderly patients
Benzo Key Clinicals
- Elderly are most likely to have S/E including falls so reduce the dose
- Rebound/withdrawal less likely with long acting benzos
- avoid in myasthenia gravis
- Avoid in liver failure
- S/E more increased with alcohol and opioids
- CYP450 drugs cause more S/E
How quickly do they work?? **
within minutes to hours
aka not much of a delay