Benzodiazepines Flashcards
What are Benzodiazepine anxiolytics effective for?
- Alleviating anxiety levels
- Muscle spasm
- Epilepsy
- Insomnia
- Alcohol withdrawal
When can Benzodiazepine anxiolytics not be used?
Cannot be used for stress, unhappiness or minor physical disease.
What can Benzodiazepines inhibit?
It can inhibit psychological adjustments in bereavement
Which patients are more likely to be dependent on Benzodiazepines?
Patients with history of alcohol or drug abuse and with marked personality disorders
What is the normal dose and duration for Benzodiazepines?
Limit to lowest possible dose for the shortest period of time
Why are beta blockers not used as anxiolytics?
And what are some benefits of using them for anxiety?
Beta blockers do not affect psychological symptoms of anxiety, like worry, fear, tension.
They reduce autonomic symptoms like palpitations, tremor.
What are some examples of Benzodiazepines?
Chlordiazepoxide
Alprazolam
Diazepam
Lorazepam
Nitrazepam
Clobazam
Midazolam
What can abrupt withdrawal of Benzodiazepines cause?
Confusion
Toxic psychosis
Convulsions
A condition resembling delirium tremens
What are the symptoms of Benzodiazepine withdrawal syndrome?
- Insomnia
- Anxiety
- Loss of appetite
- Loss of body weight
- Tremor
- Perspiration
- Tinnitus
- Perceptual disturbances
Some continue for weeks and months after stopping the medication
When can Benzodiazepine withdrawal syndrome develop? And how long do they last?
Anytime up to 3 weeks after stopping Long Acting benzodiazepine, but may occur within a day with short acting ones.
They can last for weeks or months after stopping them.
How does Benzodiazepine withdrawal work?
It is carried over a reduction rate that is tolerable to the patient.
The rate depends on initial dose, duration of use and the patients clinical response.
How long does it take short term users and long term users to withdraw?
Short terms users are people who have been using it for 2-4 weeks and it can take 2-4 weeks to withdraw.
Long term users can take several months or more to withdraw. Usually resolve within 6-18 months.
What is the protocol for withdrawing long term Benzodiazpines?
Transfer patient to equivalent dose of diazepam (preferably at night).
Reduce diazepam dose by 1-2mg every 2-4 weeks. If withdrawal symptoms occur maintain dose until symptoms lessen.
Reduce diazepam dose further if necessary in similar steps for 500mcg towards the end of the withdrawal. Then stop completely.
Can benzodiazepines be used for insomnia?
Yes, associated with anxiety.
And when it is severe, disabling or causing extreme distress.
Which patients are short acting benzodiazepines normally given to?
Patients with hepatic impairment and elderly patients
Which type of benzodiazepines carry a greater risk of withdrawal symptoms?
Short acting benzodiazepines
What are I.V Diazepams and lorazepams normally used for?
Panic attacks
What are the cautions with Benzodiazepines?
- Avoid prolonged use
- Avoid abrupt withdrawal
- Avoid use in drug/alcohol dependent/abuse patients
- Has paradoxical effects (a paradoxical increase in hostility and aggression)
What are the paradoxical effects of Benzodiazepines?
- Increase in hostility and aggression
- Effects range from talkativeness & excitement to aggression and antisocial acts
- Increased anxiety & perceptual disorders
What are the side effects of Benzodiazepines?
- Decreased alertness
- Anxiety
- Ataxia & confusion (more in elderly)
- Dizziness & drowsiness
- Fatigue
- G.I disorders
- Sleep disorders
- Muscle weakness
- Hypotension
- Altered mood
- Tremor
- Suicidal thoughts
What are the contraindications for Benzodiazepines?
- Acute pulmonary insufficiency
- Unstable myasthenia gravis
- Sleep apnoea syndrome
- Hepatic impairment; esp severe impairment
Can Benzodiazepines be used in pregnancy?
Yes, but avoid regular use. Only use if there is a CLEAR indication like seizure control.
This is because there is a risk of neonatal withdrawal symptoms when used in pregnancy
Can high doses of Benzodiazepines in late pregnancy and labour be used?
No!
Because it may cause neonatal hypothermia and hypotonia (decreased muscle tone) & respiratory depression.
Can Benzodiazepines be used when breastfeeding?
It should be avoided, as it is present in breastmilk.
What patient and carer advice should be given with Benzodiazepines?
- Drowsiness may persist the next day and affect performance of skilled task like driving
- The effects of the drug are enhanced by alcohol
- It can cause a coma with people with hepatic impairment.
Can Benzodiazepines be given to people with hepatic impairment?
Yes but should be avoided.
If necessary, use ones with shorter half lives.
Which Benzodiazepines have shorter half lives?
LLATOM
- Lormetazepam
- Loprazolam
- Temazepam
- Oxazepam
- Midazolam
- Alprazolam
These are the ones that are safer to use
