Anti-Cholinergics Flashcards
What are anti-cholinergic side effects?
- Dry mouth
- Dry eyes, sedation, constipation (ileus), blurred vision, cycloplegia, mydriasis, delirium, urinary retention, tachycardia
What is the mechanism of action of benzodiazepines?
GABA-A receptor agonists
What are the indications for benzodiazepines?
- ACUTE anxiety d/o, panic d/o, mania, seizure d/o, phobias, insomnia
- CNS depressant withdrawal protocols (i.e. alcohol withdrawal)
- Muscle spasms, agitation, catatonia, akathisia
Which benzodiazepines are not metabolized by the liver (and thus safe for patients with liver disease)?
LOT
Lorazepam
Oxazepam
Temazepam
What are the side effects of benzodiazepines?
- Sedation, dizziness, memory/cognitive slowing, addiction potential
- Respiratory depression and falls at high doses or with alcohol
- Disinhibition in susceptible individuals
What are the symptoms of withdrawal from benzodiazepines?
- Agitation, insomnia, seizures, tremors, muscle cramping, diaphoresis upon abrupt d/c
- Benzodiazepines should be tapered slowly
What benzodiazepines are more susceptible to abuse and why?
Short acting benzodiazepines like Alprazolam (Xanax) are more susceptible to abuse
Why should long acting benzodiazepines be avoided in the elderly?
Avoid long acting BZD in elderly pt’s to prevent metabolite accumulation
- Chlordiazepoxide (Librium)
- Diazepam (Valium)
What is the antidote to benzodiazepine overdose?
Can treat BZD OD with Flumazenil, a competitive GABA-A antagonist
How do the “non-benzodiazepine” benzodiazepines work?
Are all non-benzo hypnotics that bind to alpha subunit of Benzo/GABA-A receptor complex (agonist)and thus are somewhat cross reactive with BZD’s but lack significant anxiolytic, muscle relaxant, or anticonvulsant properties of BZD
- Eszopiclone (Lunesta), Zaleplon (Sonata), Zolpidem (Ambien)
