Week 13 - Benzodiazepines Flashcards
Indications
- Anxiety, panic disorders
- Alcohol withdrawal
- Seizures
- Insomnia
- Muscle spasms
- Pre-anesthesia sedation
- IBS
- Restless leg syndrome
- Chemotherapy induced N/V
MOA
Increases action of GABA (inhibitory neurotransmitter) which decreases the effect of neuronal excitation
Precautions
Psychologic/physical dependence
- Withdrawal symptoms
- Gradually taper to d/c
CNS effects
- Drowsiness, fatigue, weakness
- Ataxia
- Confusion
- Dizziness, vertigo
- Syncope
Geriatric considerations
High risk for falls
Containdications
- Pregnancy and lactation
- Hepatic and renal disease
- Children <6 years
- Hypersensitivity to benzodiazepines
- Acute narrow angle glaucoma
Drug interactions - Digoxin
Increases level of digoxin
Drug interactions - TCAs
Increases plasma level of TCAs
Drug interactions
- Barbiturates
- Nefazodone
- Fluoxetine
- Fluvoxamine
- MAOIs
- Sertraline
- Antihistamines
Increases CNS depression
Drug interactions - clozapine
Increases sedation, salivation, hypotension, delirium, respiratory arrest
True/False: Clearance of benzos may be increased by drugs or foods that inhibit CYP3A
False - decreased by drugs and food (results in enhanced/prolonged effects)
Drugs: azole antifungals, some macrolide antibiotics, HIV protease
Disadvantages of BuSpar over benzos
- Slow acting
- Takes 2-4 weeks to provide anxiety symptom relief
Advantages of BuSpar over benzos
- Less sedation and effects on coordination
- Less memory impairment
- Minimal withdrawal effects
Can benzodiazepines be prescribed in pediatrics for anxiety and schizophrenia?
Anxiety
- Clinical trials don’t support their use, but off-label use has shown to benefit children w/ severe anxiety
- Short-term therapy
Schizophrenia
- Used w/ antipsychotics meds early in acute psychosis for sedative effects
Should benzodiazepines be used during pregnancy?
No
- Increased risk of congenital malformation if taken in 1st trimester (chlordiazepoxide and diazepam)
- Can increase fetal HR if taken during labor (diazepam)
- Infants will suffer from withdrawal symptoms after birth
Should benzodiazepines be used during lactation?
When a mother takes these drugs during pregnancy and stops during breastfeeding, may notice infant irritability
- Lorazepam is the best option d/t short half-life
-
Diazepam may accumulate in the infants system
- Mothers who do take it regularly may notice sedation, lethargy, weight loss in infants
- Alprazolam not best choice d/t infant sedation
