Benzodiazapines
- Act in limbic system & reticular activating system (RAS) (blocking brain’s response to incoming stimuli)
- make GABA more effective (opens Cl- channels, hyperpolarizing cells - becomes more difficult to depolarize, reducing excitability)
- most widely used anxiolytic drugs – safer, more effective, less potential for addiction & does not cause much sedation
- Higher doses cause sedation and hypnosis
- Other uses:
- Muscle relaxants
................................................................................................................................................
Indications:- Relieve S&S of anxiety disorders
- Alcohol withdrawal
- Hyperexcitability / agitation
- Pre-op relief of anxiety & tension (lower dose)
- Balanced anesthesia
- Seizures (anticonvulsant effect)
- Conscious sedation (Producing IV anesthetic)
- Muscle spasms (Producing skeletal muscle relaxation)
- Anxiety, insomnia
Contraindications:
Caution:
- Cardiac defects
Adverse Reactions:
Interactions:
Kinetics:
Nursing Mgmt
- Psychosis
- Acute narrow angle glaucoma (May ↑ IOP)
- Shock
- Coma
- Acute alcohol intoxication
- pregnancy & lactation
Caution:
- 15% - 20% of African Americans genetically predisposed to delayed metabolism of benzodiazepines (leading to eventual buildup &↑ AE)
- Older Adults – ↑ CNS effects
- Effects on fetus and neonate:
- Cardiac defects
Adverse Reactions:
- Sedation, Drowsiness, Lethargy
- Depression, Confusion
- Blurred Vision
- Dry Mouth
- Hypotension
- urinary retention
- N/V, Constipation
- loss of libido
Interactions:
- ↑ CNS depression when taken with alcohol
- ↑ in effect when taken w/ cimetidine, oral contraceptives, or disulfiram (Antabuse)
- ↓ in effect if given with theophylline or ranitidine (Zantac)
Kinetics:
- Well absorbed from GI tract; Lipid soluble and distributes well throughout the body
- Peak levels achieved in 30 minutes to 2 hours
- Metabolized in the liver; Excretion is primarily in the urine
................................................................................................................................................
Drugs:
1. Diazepam (Valium) & Clorazepate (Tranxene) - fast onset (30min)
2. Oxazepam (Serax) - slow onset (~ 2hrs)
3. Lorazepam (Ativan), Alprazolam (Xanax), Clonazepam (Klonopin) - intermediate onset
Drugs by Use:
Drugs by Use:
- Anxiety Disorders:
- Seizure Disorders
- Insomnia
- Anesthesia
- Muscle Relaxation
- Alcohol Withdrawal
................................................................................................................................................
Nursing Mgmt
- Avoid alcohol & other CNS depressants during therapy (to avoid severe drowsiness, respiratory depression, apnea)
- Do not drive or engage in other potentially hazardous activities or those requiring mental precision until reaction to drug is known.
- Tell physician if you become or intend to become pregnant during therapy; drug may need to be discontinued.
- Take drug as prescribed; do not change dose or dose intervals.
- Check with physician before taking any OTC drugs.
- Do not breast feed while taking this drug without consulting physician.
- Psychic & physical dependence may occur in pt on LT high dosage therapy, in pt w/ Hx alcohol or drug addiction, or in pt who self-medicates
- Abrupt stop may lead to withdrawal syndrome (nausea, headache, vertigo, malaise and nightmares)
- dec dose in elderly (dec liver/kideny function)
- before using these drugs try: exercise, good sleep hygiene, relaxation techniques
- IV - do not mix with other agents; slowly - connection closest to the vein – rate (5mg/minute)– hypotension, bradycardia, cardiac arrest. BR x 3 hours post administration
- No intra-arterial administration – IV only w/ caution
- No driving or operation of heavy mechanical equipment
- Antidote:
................................................................................................................................................
Subscribe to:
Post Comments
(
Atom
)
No comments :
Post a Comment