The Benzodiazepines

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The Benzodiazepines

• Dr Brian Lam(???????)

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World s most widely prescribed

• Safety
• Anxiolytics
• Sedative-hypnotics
• Anticonvulsants
• Muscle relaxants

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Using in emergency unit

• Treatment in severe convulsions
• Care of overdoes,esp with alcoholic, TCA,
  sedative-hypnotics
• Treatment of severe withdrawl effect following
  the development of a BZD-dependent
• Use as sedative ventilator

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BZD elimination half life

• Ultrashort-acting(lt10h) Halcion (1.7 3 h)
• Short-acting(10-24h) Xanax(11-14)
• Ativan(10-20)
• Long-acting(gt24h) Valium(20-50)

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Liver illness choice BZD

• Ativan are metabolized in the liver only by
  glucuronidatiion, have no active metabolites, and
  do not appear to be affected by liver disease

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Decrease use of BZD in psychiatry

• Strong dependance
• Tolerance
• Withdrawl
• No antidepressant effect
• The appearing of SSRI replace the main role of
  choice in treating insomnia, muli-somatic
  complaint, anxiety,panic

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Never forget to treat depression before giving BZD

• Ask the s/s of depressed mood,
• Poor appetite
• General weakness
• Poor motivation
• Lack of interest
• Atypical neck stiffness,shoulder stiffness,
  chest tightness, phobia

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Good policy to treat psychosomatic

• BZD for 2 weeks
• SSRI start at first and increase slowly.
• Tappering the BZD finally

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Overdosage

• Elderly and very young children
• Limited pulmonary reservation
• Unstable cardiovascular status

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Treatment of overdose

• Gastrointestinal decontamination.
• Cathartics should not be used if the patient has
  an ileus.
• Flumazenil(anexate) is the first BZD-receptor
  antagonist.It does not appear to improve the
  general satisfactory outcome but clarify the
  diagnosis.

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Undesirable effect of Flumazenil

• Unmasking effect of proconvulsant drug induce
  convulsions and ventricular tachycardia in a
  patient after multiple drug overdose with TCA and
  a BZD.