Case #24

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If you have completed Case X, this is a review and completion of this case will not be counted toward your assignment.


Chief Complaint

You may proceed with this case only after completing (Case #23). 

Benzodiazepines, which were introduced in the 1960’s are CNS depressants – at low doses act as anxiolytics, at high doses are sedatives-hypnotics.

 

  1. Describe the pharmacokinetics (absorption, distribution, biotransformation and elimination) of benzodiazepines.
  2. How common is the use of benzodiazepines in the general population?

From the previous case, you will recall the different categories of benzodiazepines:

high potency, short-acting

  • alprazolam (Xanax)

  • lorazepam (Ativan)

  • triazolam (Halcion)

high-potency, long-acting

  • clonazepam (Klonopin) 

low potency, short-acting

  • oxazepam (Serax)

  • temazepam (Restoril)

low potency, long-acting

  • diazepam(Valium)

  • chlordiazepoxide(Librium)

  1. Do the different benzodiazepines have different rates of onset?
  2. When elderly patients and patients with liver disease (such as cirrhosis) require the use of benzodiazepines, which specific benzodiazepines are preferred?
  3. What other considerations must you consider when prescribing benzodiazepines to the elderly?
  4. Are benzodiazepines safe to use during pregnancy?
  5. With which benzodiazepines is tolerance a problem?
  6. What patients are at greatest risk for abusing benzodiazepines?
  7. What are the guidelines to follow when prescribing benzodiazepines?
  8. What are the signs and symptoms of benzodiazepine intoxication?
  9. What are the signs and symptoms of benzodiazepine withdrawal?
  10. Patient may experience inter-dose rebound anxiety or difficulty tapering and discontinuing alprazolam (Xanax). What can be done for these patients?

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