BZDs adverse effects

Question 1

On What systems of the body does BZD cause adverse effects?

Answer 1

CNS:
Cardiovascular: hypotension (especially intravenous)
Pregnancy: teratogenic effects
Drug interactions: potentiates opiates and sedatives
Physical dependence
Withdrawal syndrome

Question 2

What Adverse effects does BZDs have on the CNS?

Answer 2

• Drowsiness, sedation (Most common)
  
  • Ataxia, impaired motor coordination, driving & judgement
  • Anterograde amnesia
  • Elderly (Caution): vulnerable to confusion, amnesia & motor dysfunction; can lead to increased falls &
    fractures

Paradoxical psychological effects: excitement,
anxiety, mild euphoria and even hallucinations; due to a ‘Disinhibitory’ effect.
-

Treatment: Low dose & gradually increase dose; some
tolerance will develop

Question 3

How does BZDs cause teratogenic effects?

Answer 3

Metabolite and BZDs can cross BBB

first trimester can cause cleft palate

Third trimester fetal dependent or floppy infant syndrome

excreted in breast milk

Question 4

What are the overdose side effects?

Answer 4

rarely lethal alone

Cand cause CNS depression along with CNS depressant or death

Question 5

When does withdrawal symptoms happens with BZDs?

Answer 5

after abrupt discontinuation, return of insomnia

Question 6

What are withdrawal symptoms?

Answer 6

Confusion, anxiety, agitation, restlessness, tremor,
tachycardia and convulsions that could be life threatening.

SHORT-INTERMEDIATE (e.g., triazolam) > LONG ACTING
(e.g., flurazepam)– DO NOT ABRUPTLY Discontinue

Question 7

What is treatment for withdrawal symptoms

Answer 7

↓ DOSE BY 10-15%/wk over 4-8 wks Substitute with long-acting BZD (e.g., flurazepam)

Question 8

What is the incidence and dependence of short treatment vs chronic treatment?

Answer 8

Short Treatment: Low incidence of abuse and dependence

Chronic Treatment: Dependence can develop and result in withdrawal.

Question 9

What ai psychological and physical dependence of BZDs?

Answer 9

Psychological dependence: Relief of anxiety can lead to craving and compulsive drug-seeking behavior.

Physical dependence: An altered physiological state causing continued use of drug to prevent
withdrawal symptoms

Question 10

When is BZD dependence frequent?

Answer 10

with a history of alcohol & drug abuse

All Sed-hyp have potential for dependence & Abuse

Question 11

How does BZD addiction become addictive?

Answer 11

it activates the reward system

Question 12

What are contraindications of BZD use?

Answer 12

Known hypersensitivity (allergic rxn)
History of alcoholism or drug abuse*
Pregnancy (teratogenic effects)
Respiratory disorders 
Liver impairment (elevated BZD levels)
Elderly: need to use lower doses*
Driving, operating machinery (drowsiness)
Monitor duration of therapy - educate patient