BENZODIAZEPINES Flashcards
Benzodiazepines schedule
- CD 4 Part 1
Indications
- Short-term relief of anxiety
- For 2-4 weeks ONLY
- Must be severe anxiety (causing unacceptable distress)
- Anxiety may be in association with insomnia or other psychotic illness - Insomnia
- Again short-term use
- Only for severe disabling insomnia
When should benzodiazepines not be used?
- Long-term use (e.g. for chronic insomnia, or long term anxiety in which case other medicines should be used)
- Mild anxiety
- Elderly (Z-drug should be avoided as well) due to greater risk of ataxia and confusion (leading to falls and injury)
- Myasthenia gravis
- Respiratory impairment
- Sleep apnoea
Long-acting BDZ
Diazepam
Clobazam (adjunct in epilepsy)
Chlordiazepoxide (adjunct in acute alcohol withdrawal)
Alprazolam
Nitraxepam
Flurazepam
Shorter-acting BDZ
- Midazolam
- Oxazepam
- TEmazepam
- Loprazolam
- Lormetazepam
- Lorazepam
MOTELLL
Short acting - “Short-stay in a motel’
Use in elderly + liver impairment
Greater risk of withdrawal symptoms
What’s the advantage of short-acting benzo’s over long acting?
- They have little or no hangover effect the next day
- BUT…the withdrawal effects are felt straight away (e.g. a day) in comparison to long-acting (up to 3 weeks)
What are the advantages of long-acting benzo’s over short-acting?
- Short-acting are more likely to cause rebound insomnia (due to quick withdrawal effects felt)
- This continuous prescribing of short-acting can lead to long-term use and thus risk of dependence on it.
- Long-acting withdrawal effects are not felt as quickly as short-acting
- Long-acting also can last the whole day, so can treat insomnia at night AND anxiety during the day (2 in 1)
What does it mean by
“long-acting” and
“short-acting”?
Long-acting has a longer half-life
Short-acting means shorter half-life
When would it be suitable to use a short-acting benzodiazepine?
- Patients with sleep onset insomnia (so they can’t fall a sleep)
- AND when sedation during the day is undesirable
- Also elderly
When would it be suitable to use a long-acting benzodiazepine?
- Patients who get early morning wakening (so they need a long acting to get good sleep)
- If they get anxiety symptoms during the day (and need something to last the whole day)
BDZ - Side effects
Drowsiness
Light-headedness (the next day)
Confusion
Ataxia
BDZ - overdose
CRANDSS
Drowsiness
Dysarthria
Ataxia
Nystagmus
Respiratory depression
Sedation
Coma
Treatment for overdose
Activated charcoal - given within 1 hour of ingesting. patient must be awake and airway protected.
BDZ - Elderly
Should be avoided in the elderly.
Lower dose if used
Increased risk of confusion = falls and injury
BDZ - Dependence and withdrawal
Used for 4+ weeks = risk of dependence and withdrawal reaction.
Avoid long-term use
Avoid abrupt withdrawal
