Benzodiazepines
Benzodiazepines
Benzodiazepines are anxiolytics, antiepilep tics, muscle relaxants, and sedativehypnotics. Their exact mechanisms of action are not understood, but it is known that benzodi azepines potentiate the effects of GABA, an in hibitory neurotransmitter.
Indications
Management of anxiety disorders, short term relief of symptoms of anxiety Shortterm treatment of insomnia Alone or as adjunct in treatment of Lennox Gastaut syndrome (petit mal variant), aki netic and myoclonic seizures May be useful in patients with absence (pe tit mal) seizures who have not responded to succinimides; up to 30% of patients show loss of effectiveness of drug within 3 mo of therapy (may respond to dosage adjust ment) Unlabeled use: Treatment of panic attacks, treatment of IBS, acute alcohol withdrawal syndrome, chemotherapyinduced nausea and vomiting, psychogenic catatonic de pression, PMS Contraindications and cautions
Contraindicated with hypersensitivity to ben zodiazepines, psychoses, acute narrowangle glaucoma, shock, coma, acute alcoholic in toxication with depression of vital signs, pregnancy (risk of congenital malforma tions, neonatal withdrawal syndrome), la bor and delivery (“floppy infant” syndrome reported), or lactation (infants become lethargic and lose weight). Use cautiously with impaired hepatic or re nal function, debilitation. Adverse effects
CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fa tigue, lightheadedness, disorientation, anger, hostility, episodes of mania and hypoma nia, restlessness, confusion, crying, delir ium, headache,slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty in con centration, vivid dreams, psychomotor re tardation, extrapyramidal symptoms; mild paradoxical excitatory reactions during first 2 wk of treatment CV: Bradycardia, tachycardia, CV collapse, hypertension and hypotension, palpitations, edema Dermatologic: Urticaria, pruritus, skin rash, dermatitis EENT: Visual and auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion GI: Constipation, diarrhea, dry mouth, salivation, nausea,anorexia, vomiting, dif ficulty in swallowing, gastric disorders, he patic impairment, encopresis GU: Incontinence, urine retention, changes in libido, menstrual irregularities Hematologic: Elevations of blood enzymes—LDH, alkaline phosphatase, AST, ALT; blood dyscrasias—agranulocytosis, leu kopenia Other: Hiccups, fever, diaphoresis, paresthe sias, muscular disturbances, gynecomastia; drug dependence with withdrawal syn drome when drug is discontinued; more common with abrupt discontinuation of higher dosage used for longer than 4 mo Interactions
Drugdrug Increased CNS depression with alcohol Increased effect with cimetidine, disul firam, omeprazole, hormonal contraceptives Decreased effect with theophylline Nursing considerations
Assessment
History: Hypersensitivity to benzodiaze pines, psychoses, acute narrowangle glauco ma, shock, coma, acute alcoholic intoxica tion with depression of vital signs, pregnancy, lactation, impaired hepatic or renal func tion, debilitation Physical: Skin color, lesions; T; orienta tion, reflexes, affect, ophthalmologic ex amination; P, BP; R, adventitious sounds; liver evaluation, abdominal examination, bowel sounds, normal output; CBC, LFTs, renal function tests Interventions
Keep addictionprone patients under care ful surveillance. Monitor liver function, blood counts in pa tients on longterm therapy. Ensure ready access to bathroom if GI ef fects occur; establish bowel program if con stipation occurs. Provide frequent small meals, frequent mouth care if GI effects occur. Provide measures appropriate to care of uri nary problems (protective clothing, bed changing). Establish safety precautions if CNS changes occur (eg, side rails, accompany patient). Taper dosage gradually after longterm ther apy, especially in patients with epilepsy; arrange to substitute another antiepileptic. Monitor patient for therapeutic drug levels; levels vary with drug being used. Arrange for patient to wear medical alert identification indicating epilepsy and drug therapy. Teaching points
Take drug exactly as prescribed; do not stop taking these drugs (longterm therapy) without consulting your health care provider. Avoid alcohol, sleepinducing drugs, or over thecounter drugs. You may experience these side effects: Drowsi ness, dizziness (may become less pronounced after a few days; avoid driving or engaging in other dangerous activities); GI upset (take drug with food); fatigue; depression; dreams; 34 ? Benzodiazepines Adverse effects
in italics are most common; those in bold are lifethreatening. U Do not crush. crying; nervousness; depression, emotional changes; bed wetting, urinary incontinence. Report severe dizziness, weakness, drowsi ness that persists, rash or skin lesions, diffi culty voiding, palpitations, swelling in the extremities. Representative drugs
alprazolam chlordiazepoxide clobazam clonazepam clorazepate diazepam estazolam flurazepam lorazepam midazolam nitrazepam (CAN) oxazepam quazepam temazepam triazolam
