Download Benzodiazepines - Sarah M. Brothwell

Benzos, Downers, Nerve Pills, and Tranks
Primary Uses
 Control of acute anxiety
 Long term control of anxiety
 Insomnia
 Epilepsy
 Muscle relaxant
 Alcohol Withdrawal
 Presedation
Examples of Benzodiazepines
Drug Name
Brand Name
Therapeutic Effect
Alprazolam
Xanax, Helex, Xanor
Anxiolytic
Chlordiazepoxide
Librium, Risolid
Anxiolytic
Clonazepam
Klonopin, Rivotril, Paxam
Anxiolytic/Anticonvulsant
Diazepam
Valium, Vival, Atenex
Anxiolytic/Anticonvulsant
, Muscle Relaxant
Flunitrazepam
Rohypnol
Anxiolytic/
Hypnotic/Muscle Relaxant
Halzepam
Paxipam
Anxiolytic
Lorazepam
Ativan, Lorenin, Temesta,
Tavor,
Anxiolytic/
Anticonvulsant
Temazepan
Restoril, Normison, Tenox
Hypnotic
Tetrazepam
Mylosstan
Skeletal
A Brief History
Discovered in 1954 by Dr. Leo
Sternbach, an Austrian chemist
working for the pharmaceutical
company Hoffmann-La Roche.
In 1960, chlordiazepoxide
(Librium) was the first BZ
introduced in the United States as
an antianxiety medication.
Benzodiazepines were intended to
be a safe, non addictive
replacement for the barbiturates.
Benzodiazepines have become the
most frequently prescribed class of
psychotropic medications in the
world
How is it Taken?
BZs are usually taken in capsule or tablet
from, but some are available as an injectable
solution.
Tablets are typically pastel shades of yellow,
green, or blue.
Some users dissolve the pills in water, mix
them with other drugs, and then inject them
directly into the vein.
How it Works
Benzodiazepines are a class of drugs that produce central
nervous system (CNS) depression.
Benzodiazepines enhance the effect of the neurotransmitter
gamma-aminobutyric acid (GABA-A).
GABA is the primary inhibitory neurotransmitter. Meaning
that it tells the neurons that it comes in contact with to slow
down
How it Works Continued
Because there are millions of GABA receptors located in
many different regions of the brain BZs have a general
quieting influence on the brain.
It is still unclear whether the BZs must bind to GABAA
receptors in only one part of the brain to induce their
anxiolytic effect of if there are multiple cites of action.
GABAs inhibitory activity also leads to reduction in
excitatory neurotransmitters including norepinephrine,
serotonin, acetyl choline and dopamine.
Benzodiazepine Classification
BZs are classified by their therapeutic half-life.
a) ultra-short- acting (<4 hours)
b) short-acting (<6 hours)
c) intermediate duration (6-24 hours)
d) long-lasting (24 + hours)
Regardless of their potency, speed of elimination, or duration of
effects, actions in the body is virtually the same.
Short and intermediate acting are preferred for treatment of insomnia
Long- lasting are recommended for treatment of anxiety
Physical Effects
BZs are designed to produce feelings of relaxation and an
increased sense of well-being in the user
Other physical side effects may include
Decreased emotional reactions, mental alertness, and attention
span
Confusion
Drowsiness
Loss of coordination
Dizziness
Light headedness
Learning &
Memory
Never take Benzodiazepines while
studying!
BZ interfere with learning and memory
consolidation, partly because of
difficulties with attention and
concentration
Even when taken at normal dosage levels,
the BZ’s can interfere with normal
memory function
The mechanisms for the BZ-induced
memory impairment appears to be
similar to that of alcohol-related
“blackout,” and it will last for the
duration of the BZ’s effects on the user
Paradoxical Stimulant Effects
BZ’s occasionally cause paradoxical excitement with
increased anxiety, insomnia, nightmares, hallucinations at
the onset of sleep, irritability, hyperactivity or aggressive
behavior, and exacerbation of seizures in epileptics
Increases in irritability and common and are frequently
remarked upon by patients or by their families
The aggression/rage response appears to reflect the
benzodiazepine-induced cortical disinhibition effect
Can be likened to the effects of alcohol.
Other Side Effects
BZ-related psychomotor impairment is common. The risk of
a motor vehicle accident is significantly increased after taking
benzodiazepines.
Respiratory depression
BZs can induce, or exacerbate, a depressive thoughts or
feelings
Interference with normal sexual function in both men and
women
Suicidal thoughts
Should BZs be used as a shortterm or long-term treatment?
There is strong disagreement among medical professionals as
to whether BZ are effective in long term treatment of anxiety.
Some researchers believe that the BZ’s are only effective
anxiolytics for only 1-2 months, after which they become less
effective
Some physicians view the BZs as being effective for the
control of anxiety even over extended periods of time. There
is little evidence to suggest that patients become tolerant to
the antianxiety effects, however they may reach a plateau.
It is now common for doctors to prescribe BZs concurrently
with SSRIs for long-term antianxiety purposes. After 6-8
weeks patients should slowly discontinue their use of BZs.
Long-Term Consequences of
Benzodiazepine Use
The long-term use of BZs may lead to addiction
BZs with shorter half-lives, higher potency, and a brief duration of
action, have the greatest potential for abuse (e.g. lorazepam,
alprazolam, diazepam)
Following periods of extended use, the BZs are able to induce a
characteristic withdrawal syndrome similar to that of alcohol
Symptoms of withdrawal include: abdominal cramps agitation,
anxiety, anorexia, confusion, delirium, depersonalization,
depression, fatigue, formication, insomnia, nausea/vomiting,
nightmares, seizures, sweating, withdrawal psychosis.
Medical supervision during the withdrawal process is imperative
Types of Benzodiazepine
Abusers
Generally speaking BZ abusers fall into one of two types
(a) Those who abuse BZs to achieve a sense of euphoria
(b) Those who begin to abuse a prescribed BZ by taking more
of it, for longer periods than was prescribed
Abusers who wish to achieve a sense of euphoria are usually
polydrug abusers. BZ are used to supplement the effects of
their drug(s) of choice
BZ are also used to reduce the effects of withdrawal from
other drugs
Detection of BZ Use
Benzodiazepines are detectable in the urine for 3 days after
therapeutic use and for 4-6 weeks after chronic term use. It is
detectable in hair for 90 days after cessation and in blood for
6-48 hours.
Fun Fact
Exercise is both an antidepressant and anxiolytic
Community Resources
Alcohol and Drug Dependency Services Inc.
291 Elm Street Buffalo, NY14203
(716) 854-2997
Services: Substance abuse treatment, Detoxification, Inpatient
Rehabilitation, Residential short-term treatment (30 days or less)
Alcohol and Drug Dependency Services Family Addiction
107 Delaware Avenue Suite 555 Statler Towers Buffalo NY, 14202
(716) 855-0163
Services: Substance abuse treatment, out patient
Alcohol and Drug Dependency Services Mens
2025 Broadway Buffalo NY 14212
(716) 8927401
Services: Substance abuse treatment, Halfway house, Residential
long-term treatment
Online Resources
AlcoholDrugSOS services Addictions Counseling Online
http://www.alcoholdrugsos.com/
This site offers online answers to questions about drug and alcohol
addiction for a fee based on the complexity of the questions and
online addiction counseling
Life Recovery Program
https://www.liferecoveryprogram.com/
Online addiction recovery support program consists of biweekly
video/audio workshops, practice tools, and interactive anonymous
peer support forum.
Lion Rock Recovery
http://www.lionrockrecovery.com/online-intensive-outpatient/
Online recovery programs consist of assessment, treatment planning,
case management and transition planning for ongoing sobriety
support
Journal Articles
Evidence-based pharmacotherapy of post-traumatic stress
disorder (PTSD).
Ipser, J. C., & Stein, D. J. (2012). Evidence-based
pharmacotherapy of post-traumatic stress disorder (PTSD).
International Journal Of Neuropsychopharmacology, 15(6), 825-840.
doi:10.1017/S1461145711001209.
Refractory Generalized Convulsive Status Epilepticus: A
Guide to Treatment.
Kälviäinen, R., Eriksson, K., & Parviainen, I. (2005).
Refractory Generalised Convulsive Status Epilepticus: A Guide
to Treatment. CNS Drugs, 19(9), 759-768.
doi:10.2165/00023210-200519090-00003
Journal Articles Continued
A postmarketing study of relative abuse liability of hypnotic
sedative drugs.
Jaffe, J. H., Bloor, R., Crome, l., Carr, M., Alam, F., Simmons,
A., & Meyer, R. E. (2004). A postmarketing study of relative
abuse liability of hypnotic sedative drugs. Addiction, 99(2), 165173. doi:10.1111/j.1360-0443.2003.00631.x
Early identification, treatment, and interventions for the
prevention of benzodiazepine dependence with anxiety
disorders.
Blunk, M., & Williams, K. (2011). Early identification,
treatment, and interventions for the prevention of
benzodiazepine dependence with anxiety disorders. Mental
Health And Substance Use, 4(4), 277-292.
References
Doweiko, H.E. (2009). Abuse of and Addiction to the
Benzodiazepines and Similar Agents. In Concepts of
Chemical Dependency 8th edition (pp.73-86). La Crosse, WI:
Brooks/Cole.
Office of Diversion Control. (2010). Drugs and Chemical
Concerns. Retrieved
fromhttp://www.deadiversion.usdoj.gov/drugs_concern/be
nzo_1.htm
Gale Encyclopedia of Medicine. (2008) Benzodiazepines.
Retrieved from http://medicaldictionary.thefreedictionary.com/Benzodiazepines
References Cont.
Narconon Drug Infromation Department. (2009).
Benzodiazepines are a Popular Anti-Anxiety Drug
withAmnesia as a Side Effect. Retrieved from
http://www.narconon.org/druginformation/benzodiazepines.html