Benzodiazepines Flashcards
Name examples of benzodiazepines.
diazepam, lorazepam, chlordiazepoxide, flurazepam.
What are the indications of benzodiazepines?
severe anxiety/panic attacks (recommended for short term use only), treatment of alcohol withdrawal (chlordiazepoxide), muscle spasms (diazepam), tetanus (diazepam), insomnia, cerebral palsy, premedication/sedation for procedures (diazepam), epilepsy/seizures/status epilepticus/febrile convulsions/convulsions caused by poisoning.
What are the contraindications of benzodiazepines?
acute pulmonary insufficiency, marked neuromuscular respiratory weakness, sleep apnoea syndrome, unstable myasthenia gravis, hyperkinesis, obsessional states, phobic states, respiratory depression, coma (clonazepam), current alcohol/drug abuse (clonazepam), avoid injections containing benzyl alcohol in neonates, CNS depression, compromised airway.
State the mechanism of action of benzodiazepines.
Benzodiazepines are GABA-A receptor antagonists. This means they enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor. Neurotransmitters are chemical messengers that carry electrical signals between nerve cells. The role of GABA is to reduce or inhibit neuron activity, resulting in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant effects. Some benzodiazepines such as clonazepam also work as serotonin agonists (enhance serotonin).
What are the very common/common unwanted side-effects of benzodiazepines?
amnesia, ataxia, bronchial/salivary hypersecretion in infants and young children, confusion, coordination disturbances, dependency, dizziness, drowsiness the following day, fatigue, light-headedness the following day, muscle weakness, nystagmus, paradoxical increase in aggression, poor concentration, restlessness, tremor, withdrawal symptoms (anxiety, panic, palpitations, sweating, tremor, gastrointestinal disorders, irritability, aggression, disrupted sensory perception, muscle spasms, general malaise, loss of appetite, paranoid psychosis, delirium and epileptic attacks).
What is the treatment cessation protocol for benzodiazepines?
After taking benzodiazepines long term, withdrawal should be gradual as stopping abruptly may cause confusion, toxic psychosis, convulsions etc. Withdrawal should be flexible and carried out at a rate tolerant by the patient. Short term use of benzodiazepines can usually be tapered off within 2-4 weeks. Long term use may require tapering of several months or more. Withdrawal protocol involves transferring patients to equivalent dose of diazepam to be taken at night, and reduced by 1-2 mg every 2-4 weeks.
What is the patient and carer advice for benzodiazepines?
Advise patients/carers that drowsiness may persist the following day and can affect driving and/or performance of skilled tasks/operating machinery. Benzodiazepines generally increase the effects of alcohol. Advise patients on legal matters of driving whilst taking controlled drugs.
