Randy Brown

3/16/06

[Slide 1] BENZODIAZEPINES AND SIMILAR DRUGS

Misuse, abuse and dependence

 

V.     Introduction

A.     Overview

1.      Benzodiazepines (BZDs) = CNS depressants; useful for many disorders

a.      Medical disorders. Examples include:

i.                    Muscular spasm in cerebral palsy, paraplegia

ii.                  Involuntary movements e.g. myoclonus (twitching or spasm of muscle or group of muscles), restless leg syndrome

iii.                Convulsive disorders (epilepsy)

iv.                 Sedation prior to endoscopy/minor surgery

b.      Psychiatric disorders. Examples include:

i.                    Anxiety disorders and Sx

a.      E.g. panic attacks1 = discrete period of intense fear in absence of real danger + ≥ 4/13 somatic or cognitive sx. Examples:

i.        Palpitations

ii.      Sweating

iii.    Trembling

iv.     Shortness of breath

v.       Chest pain

vi.     Nausea/abdominal distress

ii.                  Anxiety/sleep disturbance due to stresses; work shift change; jet lag

(Note to speaker: mouse click ŕ text box “BUT. . .”

2.      [Slide 2] Key Points However, BZDs can cause problems

a.      Long-term BZD use (> 2 weeks) risky: adverse effects, misuse, abuse and dependence.

b.      Certain situations ↑ risk ŕ we can reduce risk:benefit

i.                    Prescribing practice/med characteristics

a.      Specific BZD prescribed (pharmacology important here)

b.      Dose

c.      Duration

ii.                  Patient characteristics. For example

a.      Age

b.      Co-morbid illness

c.      Long-term use (> 2 weeks) ŕ physiologic adaptation to BZDs ŕ withdrawal syndrome with abrupt discontinuation or drastic dose reduction. So, taper BZDs = slow (generally 4-20 weeks).

VI.   Patient Ken = 30 yo healthy male with ~1 year c/o persistent anxious feelings, difficulty concentrating, difficulty sleeping. Prior relief with diazepam from a friend’s supply. Requests daily diazepam. At first, we may want to help and provide the diazepam. Is this really in patient’s best interests?

VII.  [Slide 3] What are BZs (and related agents)?

A.     Benzodiazepines (BZDs) = Central nervous system depressants acting via GABA receptor. Often used as sedative/hypnotic (sleep-inducing agent) or anxiolytic (anxiety-relieving agent). 2-4 Common examples:

1.      Sedative/hypnotics

·        Flurazepam (Dalmane)

·        Temazepam (Restoril)

·        Triazolam (Halcion)        

2.      Anxiolytics

·        Alprazolam (Xanax)

·        Chlordiazepoxide (Librium)

·        Clonazepam (Klonopin)

·        Diazepam (Valium)        

B.     Non-BZD benzodiazepine receptor agonists (BZRAs) = Also = CNS depressants acting at the GABA receptor. Used primarily for sedative/hypnotic effects. Selectivity ŕ less anxioltic

·        Zaleplon (Sonata)

·        Zolpidem (Ambien)

·        Eszopiclone (Lunesta)

Though these medications are useful in certain clinical settings over the short term, there are risks with long-term prescribing to keep in mind

V.     [Slide 4] Adverse effects

A.     Motor impairment

1.      Impaired motor skills (e.g. slowed response time, ↓ driving skills)