N165 Exam #4 Medication Review

1. Depression
a. Benzodiazepines
i. Indications: short-term use in anxiety, insomnia. ER management of
seizures. Also used to treat muscle spasms, alcohol withdrawal, and as
pre-op sedative
ii. Safer than older barbiturates, however tolerance to some effects can still
develop and drugs have potential for physical dependence and abuse
1. Rapid withdrawal can precipitate seizures, paranoia, delirium,
especially if dose was high and medication taken long-
term .Benzodiazepines must be tapered to discontinue
2. Well-absorbed orally
3. Lipophilic – penetrate blood-brain barrier to act in CNS
4. Most undergo extensive metabolism to pharmacologically active
metabolites – long-lasting effects
5. Hepatic metabolism may be a contraindication for some
benzodiazepines in liver disease
6. Weak respiratory depression when used alone
7. CNS depression (drowsiness) and horrible CNS depression if mixed
with alcohol (EtOH), opioids, or barbiturates  respiratory
depression, coma, and death
8. BBW to all opioids when mixed with BZDs will cause profound
sedation, respiratory depression, coma, and death
9. On Beers List of medications to avoid in geriatric patients
10. Reversal agent is FLUMAZENIL which can reverse the sedative
effects of benzodiazepines but not the respiratory depression part
11. Sleep driving and other sleep-related behaviors – exacerbated by
comibination with alcohol land other CNS depressants
12. Pardxocail effects (agitation)
13. IV administration can result in hypotension and cardiac arerest
14. Congenital malformations if iused in first trimester of pregnancy,