Benzodiazepines

Question 1

List the benzodiazepine drugs available? (11)

Answer 1

1. Alprazolam
2. Bromazepam
3. Clobazam
4. Clonazepam
5. Diazepam
6. Flunitrazepam
7. Lorazepam
8. Midazolam
9. Nitrazepam
10. Oxazepam
11. Temazepam

Question 2

How does benzodiazepines work?

Answer 2

Benzodiazepines potentiate the inhibitory effects of GABA throughout the CNS, resulting in anxiolytic, sedative, hypnotic, muscle relaxant, and antiepileptic effects.

Question 3

What are the precautions for benzodiazipine use?

Answer 3

1. Taking drugs that cause CNS and respiratory depression
2. Respiratory
3. Musculoskeletal
4. Dependence
5. Renal
6. Hepatic
7. Elderly
8. Children
9. Pregnancy
   10 Breastfeeding

Question 4

Which benzodiazepines are metabolites of diazepam?

Answer 4

Oxazepam and temazepam are metabolites of diazepam

Question 5

Explain the precaution surrounding co-administration of a benzodiazepine and other drugs that cause CNS and respiratory depression?

Answer 5

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

Question 6

What is the respiratory precaution with benzodiazepine use?

Answer 6

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)

Question 7

What is the musculoskeletal precaution with benzodiazepine use?

Answer 7

Contraindicated in myasthenia gravis

Muscle weakness may worsen.

Question 8

Explain the precaution surrounding benzodiapine’s and dependence risk?

Answer 8

Use of benzodiapines can lead to physical and psychological dependence (even for short periods), tolerance and misuse.

Question 9

What are some of the signs of dependence?

Answer 9

Drug-seeking behaviour, craving, and disturbed work and personal function.

Question 10

What are some factors which may increase risk of dependence developing in patients with benzodiazepine use?

Answer 10

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.

Question 11

What can cause withdrawal effects with benzodiazepine use?

Answer 11

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)

Question 12

What is the renal precaution with benzodiazepine use?

Answer 12

Increased sensitivity to CNS effects in renal impairment; use a lower initial dose in severe impairment.

Question 13

What is the hepatic precaution with benzodiazepine use?

Answer 13

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.

Question 14

What is the elderly precaution with benzodiazepine use?

Answer 14

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.

Question 15

What are the common adverse effects for benzodiazepines?

Answer 15

Drowsiness
Oversedation
Light-headedness
Hypersalivation
Ataxia
Slurred speech
Dependence
Effects on vision (i.e. blurred vision)

Question 16

What are the infrequent adverse effects of benzodiazepines?

Answer 16

Headache
Vertigo
Disorientation 
Confusion 
Paradoxical excitation 
Euphoria
Aggression and hostility 
Anxiety 
Decreased libido
Anterograde amnesia
Respiratory depression 
Hypotension

Question 17

Are short-acting or long-acting agents more likely to cause withdrawal symptoms?

Answer 17

Short-acting agents (particularly those with rapid onset of action) are more likely to lead to acute withdrawal symptoms

Question 18

Which benzodiazepine is less likely to cause withdrawal?

Answer 18

Diazepam’s rapid onset of action and long half-life means it is associated with less withdrawal.

Question 19

Which benzodizapine’s are preferred when using as prophylaxis against withdrawal from alcohol, barbituates or other benzodiapines?

Answer 19

long-acting agents; diazepam, clonazepam are preferred.

Question 20

Which benzodiazepines are used for treatment of anxiety?

Answer 20

Diazepam, lorazepam, oxazepam

Question 21

Which benzodiazepine is used for treatment of insomnia and which benzodiazepine is NOT suitable for treatment of insomnia?

Answer 21

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.

Question 22

Which benzodiazepines are controlled drugs?

Answer 22

1. Flunitrazepam

2. Alprazolam