BZD

• Drugs: Alprazolam (Xanax), Lorazepam (Ativan), Diazepam (Valium), Temazepam (Restoril), Midazolam (Versed), Oxazepam (Serax), Clonazepam (Klonopin), Librium(chlordiazepoxide), Tranxene (clorazepate)
• Potentiate GABA – an inhibitory neurotransmitter that causes CNS depression
• Common use: Anxiety, insomnia, sedation, seizures, muscle spasm, alcohol withdraw. Control substance C-IV.
• SE: sedation(fall risk in elderly), slurred speech, confusion, anterograde amnesia, just like alcohol in pill form.
• Can cause birth defect (cleft lip) if used in pregnancy
• LOT (lorazepam, oxazepam, temazepam): safer drug of choice for elderly patients because they are less hepatic harmful - metabolized to inactive compounds- glucuronides
• Used for muscle spasticity: Valium, its rectal form used for seizure.
• Avoid other sedating drugs: pain meds, muscle relaxant, antihistamine, antidepressant, alcohol
• Quazepam(Doral), flurazepam (Dalmane): caution in elderly due to long half life

 

Buspirone (Buspar)

• MOA: Not well known, possible effect on 5HT, dopamine.
• Well tolerated with little abuse potential, a much safer choice for anxiety compared to BZDs.
• Disadvantage: Slow onset, takes weeks to see benefit (not for prn use).

 

 

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