Benzodiazepines Flashcards
List the benzodiazepine drugs available? (11)
- Alprazolam
- Bromazepam
- Clobazam
- Clonazepam
- Diazepam
- Flunitrazepam
- Lorazepam
- Midazolam
- Nitrazepam
- Oxazepam
- Temazepam
How does benzodiazepines work?
Benzodiazepines potentiate the inhibitory effects of GABA throughout the CNS, resulting in anxiolytic, sedative, hypnotic, muscle relaxant, and antiepileptic effects.
What are the precautions for benzodiazipine use?
- Taking drugs that cause CNS and respiratory depression
- Respiratory
- Musculoskeletal
- Dependence
- Renal
- Hepatic
- Elderly
- Children
- Pregnancy
10 Breastfeeding
Which benzodiazepines are metabolites of diazepam?
Oxazepam and temazepam are metabolites of diazepam
Explain the precaution surrounding co-administration of a benzodiazepine and other drugs that cause CNS and respiratory depression?
Taking drugs that cause CNS and respiratory depression (e.g. opioids) - administration with a benzodiazepine increase the risk of these effects (including coma and death); avoid use or reduce benzoodiazepine dose and monitor closely
What is the respiratory precaution with benzodiazepine use?
Benzodiazepine’s are contraindicated in respiratory depression.
Compromised respiratory drive in respiratory disease or sleep apnoea may result in hypoventilation and hypoxaemia (low O2 in blood)
What is the musculoskeletal precaution with benzodiazepine use?
Contraindicated in myasthenia gravis
Muscle weakness may worsen.
Explain the precaution surrounding benzodiapine’s and dependence risk?
Use of benzodiapines can lead to physical and psychological dependence (even for short periods), tolerance and misuse.
What are some of the signs of dependence?
Drug-seeking behaviour, craving, and disturbed work and personal function.
What are some factors which may increase risk of dependence developing in patients with benzodiazepine use?
Factors such as history of alcohol or drug misuse, marked personality disorder, high doses and regular use increase the risk.
Avoid prescribing benzo’s in patients with a Hx of alcohol or drug misuse.
What can cause withdrawal effects with benzodiazepine use?
Suddenly stopping the drug (or reducing or tapering the drug too quickly) can cause withdrawal symptoms. Rebound effects can occur (return of original symptoms with greater severity)
What is the renal precaution with benzodiazepine use?
Increased sensitivity to CNS effects in renal impairment; use a lower initial dose in severe impairment.
What is the hepatic precaution with benzodiazepine use?
Contraindicated in severe hepatic impairment, particularly when hepatic encephalopathy is present.
In mild-moderate impairment, use low doses of a short-acting benzodiazepine to reduce risk of precipitating a coma.
What is the elderly precaution with benzodiazepine use?
Increased risk of oversedation, ataxia, confusion, memory impairment, falls and respiratory depression. If a benzodiazepine is necessary, use short term and in low doses, and avoid long-acting agents.
What are the common adverse effects for benzodiazepines?
Drowsiness Oversedation Light-headedness Hypersalivation Ataxia Slurred speech Dependence Effects on vision (i.e. blurred vision)
What are the infrequent adverse effects of benzodiazepines?
Headache Vertigo Disorientation Confusion Paradoxical excitation Euphoria Aggression and hostility Anxiety Decreased libido Anterograde amnesia Respiratory depression Hypotension
Are short-acting or long-acting agents more likely to cause withdrawal symptoms?
Short-acting agents (particularly those with rapid onset of action) are more likely to lead to acute withdrawal symptoms
Which benzodiazepine is less likely to cause withdrawal?
Diazepam’s rapid onset of action and long half-life means it is associated with less withdrawal.
Which benzodizapine’s are preferred when using as prophylaxis against withdrawal from alcohol, barbituates or other benzodiapines?
long-acting agents; diazepam, clonazepam are preferred.
Which benzodiazepines are used for treatment of anxiety?
Diazepam, lorazepam, oxazepam
Which benzodiazepine is used for treatment of insomnia and which benzodiazepine is NOT suitable for treatment of insomnia?
Temazepam is a suitable choice for insomnia (rapid onset of action, short half life); nitrazepam is not suitable because of it’s long half-life.
Which benzodiazepines are controlled drugs?
- Flunitrazepam
2. Alprazolam
