benzodiazepines Flashcards
MHRA advice - all BZDPNs (+ like drugs) and opioids
- reminder of risk of potentially fatal respiratory depression
- co prescribed = can produce additive CNS depressant effects, thereby increasing risk of sedation, respiratory depression, coma, death
- only co prescribe if no alternative and if necessary give lowest possible dose for shortest possible. duration
a patient has been co prescribed BZDPN and opioid. what do you monitor
Patients should be closely monitored for signs of respiratory depression at initiation of treatment and when there is any change in prescribing, such as dose adjustments or new interactions.
if methadone is co prescribed with BZDPN or BDZPN like drug …
respiratory depressant effect of methadone may be delayed; patients should be monitored for at least 2 weeks after initiation or changes in prescribing. Patients should be informed of the signs and symptoms of respiratory depression and sedation, and advised to seek urgent medical attention should these occur.
CI for all BZDPNS
Acute pulmonary insufficiency; marked neuromuscular respiratory weakness; not for use alone to treat chronic psychosis; not for use alone to treat depression (or anxiety associated with depression); obsessional states; phobic states; sleep apnoea syndrome; unstable myasthenia gravis
Paradoxical effects
A paradoxical increase in hostility and aggression may be reported by patients taking benzodiazepines. The effects range from talkativeness and excitement to aggressive and antisocial acts. Adjustment of the dose (up or down) sometimes attenuates the impulses. Increased anxiety and perceptual disorders are other paradoxical effects.
all interactions are to do with this SE
sedation
CNS depressant effects (opioids)
is ataxia a common SE?
yes more common in elderly
overdose signs
Benzodiazepines taken alone cause drowsiness, ataxia, dysarthria (difficulty speaking becuause of weak mouth muscles), nystagmus, and occasionally respiratory depression, and coma.
treatment of BZDPN poisoning (non drug)
Charcoal, activated can be given within 1 hour of ingesting a significant quantity of benzodiazepine, provided the patient is awake and the airway is protected.
treatment of BZDPN poisoning (drug + important points)
Benzodiazepines potentiate the effects of other central nervous system depressants taken concomitantly. Use of the benzodiazepine antagonist flumazenil [unlicensed indication] can be hazardous, particularly in mixed overdoses involving tricyclic antidepressants or in benzodiazepine-dependent patients. Flumazenil may prevent the need for ventilation, particularly in patients with severe respiratory disorders; it should be used on expert advice only and not as a diagnostic test in patients with a reduced level of consciousness.
Driving and skilled tasks
May cause drowsiness, impair judgement and increase reaction time, and so affect ability to drive or perform skilled tasks; effects of alcohol increased. Moreover the hangover effects of a night dose may impair performance on the following day.
Flurazepam dose insomnia short term use
15-30mg OD at bedtime
debilitated pt or elderly, 15mg OD bedtime
Loprazaolam insomnia short term use dose
1mg OD, then increased to 1.5-2mg OD if requires, at bed time
debilitated or elderly: 0.5-1mg OD at bedtime
use in pregnancy for all BZDPNS
Risk of neonatal withdrawal symptoms when used during pregnancy. Avoid regular use and use only if there is a clear indication such as seizure control. High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression.
use in BF for all BZDPNs
Benzodiazepines are present in milk, and should be avoided if possible during breast-feeding.
