BZDPN & withdrawal Flashcards
why is it difficult to withdraw anxiolytics (sedatives) and hypnotics after they have been taken regularly for more than a few weeks?
dependence (physical and psychological) and tolerance occur
what are the most commonly used anxiolytics & hypnotics
BZDPNs
where do BZDPNs act on
BZDPN receptors which are associated with gamma-aminobutyric acid (GABA) receptors
BZDPN indications (2 - anxiety and insomnia)
- short term relief (2-4 weeks only) of anxiety that is severe, disabling, or causing the pt unacceptable distress, occurring alone or in association with insomnia or short term psychosomatic, organic, or psychotic illness
- treatment of insomnia only when it is severe, disabling or causing the pt extreme distress
can you use BZDPN to treat short term mild anxiety
inappropriate
why does withdrawal of BZDPN need to be gradual and not abrupt
because can produce confusion, toxic psychosis, convulsions, or a condition resembling delirium tremens
when may BDZPN withdrawal syndrome develop after stopping a long acting BZDPN (e.g. diazepam, chlordiazepoxide, clonazepam)
at any time up to 3 weeks after stopping LA-BZDPN
when may BDZPN withdrawal syndrome develop after stopping a SA BZDPN (e.g. lorazepam, oxazepam, alprazolam)
can occur within a day
BZDPN withdrawal syndrome is characterised by
insomnia
anxiety
loss of appetite
loss of body weight
tremor
perspiration
tinnitus
perceptual disturbances
what will symptoms of BZDPN withdrawal syndrome sometimes encourage further prescribing of BZDPNs?
Some symptoms may be similar to the original complaint and encourage further prescribing; some symptoms may continue for weeks or months after stopping benzodiazepines.
BZDPN withdrawal should be flexible and carried out at a reduction rate that is tolerable for the patient. Rate should depend on … (3)
initial dose of BZDPN
duration of use
pt clinical response
BZDPN withdrawal should be flexible and carried out at a reduction rate that is tolerable for the pt. short term users of BZDPNs (2-4 weeks only) can usually taper off within …. weeks
2-4 weeks
Benzodiazepine withdrawal should be flexible and carried out at a reduction rate that is tolerable for the patient. Short-term users of benzodiazepines (2–4 weeks only) can usually taper off within 2–4 weeks. However, long-term users should be withdrawn ….
over a much longer period of several months or more
Suggested protocol for withdrawal for prescribed long term BZDPN pt
- transfer pt stepwise, one dose at a time over about a week, to an equivalent daily dose of diazepam, preferably taken at night
- reduce diazepam dose (usually by 1-2mg every 2-4 weeks - in pt taking high doses BZDPNs, initially it may be appropriate to reduce dose by up to 1/10th every 1-2 weeks)
- if uncomfortable withdrawal symptoms occur, maintain this dose until symptoms lessen
- reduce diazepam dose further, if necessary in smaller steps - steps of 500mcg may be appropriate towards the end of withdrawal
- then stop completely
when you are withdrawing long term BZDPN from patients, the period needed to complete withdrawal may vary from …
several months to a year or more
when you are withdrawing for prescribed long term BZDPN patients, you switch them to an equivalent daily dose of this drug and taper till stopping
diazepam
withdrawal symptoms for long term users usually resolve with …. months of the last dose
6-18 months
some patients will recover more quickly, others may take longer
the addition of these drugs should be avoided where possible when a patient is being withdrawn from BZDPN (3)
BB
antidepressants
antipsychotics
BZDPNs - paradoxical effects
paradoxical increase in hostility and aggression may be reported by pt taking BZDPNs
effects range from talkativeness and excitement to aggressive and antisocial acts
adjustment of dose up or down sometimes attenuates the impulses
other paradoxical effects: increased anxiety and perceptual disorders
