Benzodiazepines

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Benzodiazepines WHAT ARE BENZODIAZEPINES? (Ativan®), oxazepam (Serax®), prazepam Benzodiazepines are depressants that produce (Centrax®), and quazepam (Doral®). Clonazepam sedation and hypnosis, relieve anxiety and muscle (Klonopin®), diazepam, and clorazepate are also spasms, and reduce seizures. used as anticonvulsants. WHAT IS THEIR ORIGIN? How are they abused? Benzodiazepines are only legally available through Abuse is frequently associated with adolescents prescription. Many users maintain their drug supply and young adults who take the drug orally or crush by getting prescriptions from several doctors, it up and snort it to get high. forging prescriptions, or buying them illicitly. Abuse is particularly high among heroin and Alprazolam and clonazepam are the two most cocaine users. Additionally, opioid users often co- frequently encountered benzodiazepines on the abuse benzodiazepines to enhance euphoria. illicit market. What is their effect on the mind? What are common street names? Benzodiazepines are associated with amnesia, Common street names include Benzos and hostility, irritability, and vivid or disturbing dreams. Downers. What is their effect on the body? What do they look like? Benzodiazepines slow down the central nervous The most common benzodiazepines are the system and may cause sleepiness and relaxed prescription drugs Valium®, Xanax®, Halcion®, mood. Ativan®, and Klonopin®. Tolerance can develop, although at variable rates and to different degrees. What are their overdose effects? Shorter-acting benzodiazepines used to Effects of overdose include: manage insomnia include estazolam (ProSom®), • Extreme drowsiness, confusion, impaired coordination, flurazepam (Dalmane®), temazepam (Restoril®), decreased reflexes, respiratory depression, coma, and and triazolam (Halcion®). Midazolam (Versed®), possible death. Overdose effects of concomitant use of a short-acting benzodiazepine, is utilized for benzodiazepines and opioids include: Profound sedation, sedation, anxiety, and amnesia in critical care respiratory depression, coma, and death. settings and prior to anesthesia. It is available in the United States as an injectable preparation and Which drugs cause similar effects? as a syrup (primarily for pediatric patients). Drugs that cause similar effects include: Benzodiazepines with a longer duration of • Alcohol, barbiturates, sleeping pills, and GHB action are utilized to treat insomnia in patients with daytime anxiety. These benzodiazepines What is their legal status in the United States? include alprazolam (Xanax®), chlordiazepoxide Benzodiazepines are controlled in Schedule IV of (Librium®), clorazepate (Tranxene®), diazepam the Controlled Substances Act. (Valium®), halazepam (Paxipam®), lorzepam .

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Diazepam - Alcohol Withdrawal
Diazepam - alcohol withdrawal Why have I been prescribed diazepam? If a person stops drinking alcohol after a time of drinking too much they can experience withdrawal effects. These include “the shakes”, sweating, having fits, seeing things which are not there (hallucinations) and feeling anxious and low in mood. They can feel wound up and find it difficult to sleep. These withdrawal effects can be very uncomfortable and in extreme cases can be dangerous if they persist into “DTs” (delirium tremens). Diazepam is used to help reduce these withdrawal symptoms. It relieves anxiety and tension and aids sleep. Diazepam can also prevent fits. It controls the withdrawal symptoms until the body is free of alcohol and has settled down. This usually takes three to seven days from the time you stop drinking. What exactly is diazepam? Diazepam is a benzodiazepine. This group of medicines is also called anxiolytics or minor tranquillisers. Diazepam has many uses. It can be used to reduce symptoms of anxiety and insomnia, as well as to help people come off alcohol. Diazepam should only be prescribed and taken as a short course. Is diazepam safe to take? Diazepam is safe to take for a short period of time, but it doesn’t suit everyone. Below are a few conditions where diazepam may be less suitable. If any of these apply to you please tell your doctor or key-worker. If you have depression or a mental illness If you have lung disease or breathing problems, or suffer from liver or kidney trouble If you take any other medicines or drugs, including those on prescription and bought from a chemist If you take illicit drugs bought “on the street” If you are pregnant or breast-feeding What is the usual dose of diazepam? The dose of diazepam will usually be started at 10-20mg four times a day.
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Insomnia and Anxiety in Older People Sleeping Pills Are Usually Not the Best Solution
® Insomnia and anxiety in older people Sleeping pills are usually not the best solution lmost one-third of older people in the people who take one of United States take sleeping pills. These these medicines sleep medicines are also sometimes called only a little longer and A“sedative-hypnotics” or “tranquilizers.” They better than those who affect the brain and spinal cord. don’t take a medicine. Doctors prescribe some of these medicines Sleeping pills can for sleep problems. Some of these medicines have serious side effects. also can be used to treat other conditions, such All sedative-hypnotic medicines have special as anxiety or alcohol withdrawal. Sometimes, risks for older adults. Seniors are likely to be doctors also prescribe certain anti-depressants more sensitive to the medicines’ effects than for sleep, even though that’s not what they’re younger adults. And these medicines may designed to treat. stay in older people’s bodies longer. These Most older adults should first try to treat their medicines can cause confusion and memory insomnia without medicines. According to the problems that: American Geriatrics Society, there are safer and • Increase the risk of falls and hip fractures. better ways to improve sleep or reduce anxiety. These are common causes of hospital stays Here’s why: and death in older people. Sleeping pills may not help much. • Increase the risk of car accidents. Many ads say that sleeping pills help people get a full, restful night’s sleep. But studies show that this is not exactly true in real life. On average, The new “Z” medicines also have risks.
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What Is Diazepam?
Diazepam (Di-a-ze-pam) Valium™ Patient Name: ___________________________________ Date: _____________________________________________ Doctor Name: ___________________________________ Emergency Number: ________________________________ Pharmacy: _____________________________________ Number: __________________________________________ What is Diazepam? • Diazepam is a medicine approved by the Food and Drug Administration to treat all types of seizures, including absence, myoclonic, atonic (drop attacks), partial seizures and seizures associated with Lennox-Gastaut syndrome. • It is most often used together with another antiepileptic drug. It is also used in emergency situations involving seizures. It may also be used for other conditions as well as seizures, such as anxiety. • The drug is quickly absorbed after taking it by mouth and it reaches its highest amount in the body in 1-2 hours. A rectal form of the medicine called diastat is also available. Important questions to ask your doctor: • Why am I being given this medicine? _________________________________________________________________ • What amount should I be taking? ____________________________________________________________________ What does this drug look like and how should I take it? There are several brands and generic forms of the medicine. The brand name Valium is shown below at the 0.5 mg pill, the 1 mg pill and the 2 mg pill and the generic form lorazepam at 1 mg pill is also shown. 10 mg diazepam 10 mg diazepam 2 mg diazepam 10 mg diazepam 5 mg diazepam 2 mg diazepam 5 mg diazepam 2 mg diazepam 10 mg Valium 5 mg Valium 2 mg Valium © 2010 epilepsy.com A service of the Epilepsy Foundation Diazepam (Di-a-ze-pam) Valium™ Frequently Asked Questions: How do I take Diazepam? To use the tablet form: chew tablets and swallow or swallow the tablet whole.
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Drug & Alcohol Testing Program
Pottawattmie County Drug & Alcohol Testing Program Appendix A Table of Contents POLICY STATEMENT ...................................................................................................................................... 3 SCOPE ............................................................................................................................................................ 4 EDUCATION AND TRAINING .......................................................................................................................... 4 DESIGNATED EMPLOYER REPRESENTATIVE (DER): ....................................................................................... 5 DUTY TO COOPERATE ................................................................................................................................... 5 EMPLOYEE ADMISSION OF ALCOHOL AND CONTROLLED SUBSTANCE USE: (49 CFR Part 382.121) ... 6 PROHIBITED DRUGS AND ILLEGALLY USED CONTROLLED SUBSTANCES: ..................................................... 7 PROHIBITED BEHAVIOR AND CONDUCT: ...................................................................................................... 8 DRUG & ALCOHOL TESTING REQUIREMENTS (49 CFR, Part 40 & 382) ............................................... 10 DRUG & ALCOHOL TESTING CIRCUMSTANCES (49 CFR Part 40 & 382) .............................................. 12 A. Pre-Employment Testing: .................................................................................................... 12 B. Reasonable Suspicion Testing: .........................................................................................
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Management of Status Epilepticus
Published online: 2019-11-21 THIEME Review Article 267 Management of Status Epilepticus Ritesh Lamsal1 Navindra R. Bista1 1Department of Anaesthesiology, Tribhuvan University Teaching Address for correspondence Ritesh Lamsal, MD, DM, Department Hospital, Institute of Medicine, Tribhuvan University, Nepal of Anaesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University,Kathmandu, Nepal (e-mail: [email protected]). J Neuroanaesthesiol Crit Care 2019;6:267–274 Abstract Status epilepticus (SE) is a life-threatening neurologic condition that requires imme- diate assessment and intervention. Over the past few decades, the duration of seizure Keywords required to define status epilepticus has shortened, reflecting the need to start thera- ► convulsive status py without the slightest delay. The focus of this review is on the management of con- epilepticus vulsive and nonconvulsive status epilepticus in critically ill patients. Initial treatment ► neurocritical care of both forms of status epilepticus includes immediate assessment and stabilization, ► nonconvulsive status and administration of rapidly acting benzodiazepine therapy followed by nonbenzodi- epilepticus azepine antiepileptic drug. Refractory and super-refractory status epilepticus (RSE and ► refractory status SRSE) pose a lot of therapeutic problems, necessitating the administration of contin- epilepticus uous infusion of high doses of anesthetic agents, and carry a high risk of debilitating ► status epilepticus morbidity as well as mortality. ► super-refractory sta- tus epilepticus Introduction occur after 30 minutes of seizure activity. However, this working definition did not indicate the need to immediately Status epilepticus (SE) is a medical and neurologic emergency commence treatment and that permanent neuronal injury that requires immediate evaluation and treatment. It is associat- could occur by the time a clinical diagnosis of SE was made.
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Drugs Inducing Insomnia As an Adverse Effect
2 Drugs Inducing Insomnia as an Adverse Effect Ntambwe Malangu University of Limpopo, Medunsa Campus, School of Public Health, South Africa 1. Introduction Insomnia is a symptom, not a stand-alone disease. By definition, insomnia is "difficulty initiating or maintaining sleep, or both" or the perception of poor quality sleep (APA, 1994). As an adverse effect of medicines, it has been documented for several drugs. This chapter describes some drugs whose safety profile includes insomnia. In doing so, it discusses the mechanisms through which drug-induced insomnia occurs, the risk factors associated with its occurrence, and ends with some guidance on strategies to prevent and manage drug- induced insomnia. 2. How drugs induce insomnia There are several mechanisms involved in the induction of insomnia by drugs. Some drugs affects sleep negatively when being used, while others affect sleep and lead to insomnia when they are withdrawn. Drugs belonging to the first category include anticonvulsants, some antidepressants, steroids and central nervous stimulant drugs such amphetamine and caffeine. With regard to caffeine, the mechanism by which caffeine is able to promote wakefulness and insomnia has not been fully elucidated (Lieberman, 1992). However, it seems that, at the levels reached during normal consumption, caffeine exerts its action through antagonism of central adenosine receptors; thereby, it reduces physiologic sleepiness and enhances vigilance (Benington et al., 1993; Walsh et al., 1990; Rosenthal et al., 1991; Bonnet and Arand, 1994; Lorist et al., 1994). In contrast to caffeine, methamphetamine and methylphenidate produce wakefulness by increasing dopaminergic and noradrenergic neurotransmission (Gillman and Goodman, 1985). With regard to withdrawal, it may occur in 40% to 100% of patients treated chronically with benzodiazepines, and can persist for days or weeks following discontinuation.
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Understanding Benzodiazephine Use, Abuse, and Detection
Siemens Healthcare Diagnostics, the leading clinical diagnostics company, is committed to providing clinicians with the vital information they need for the accurate diagnosis, treatment and monitoring of patients. Our comprehensive portfolio of performance-driven systems, unmatched menu offering and IT solutions, in conjunction with highly responsive service, is designed to streamline workflow, enhance operational efficiency and support improved patient care. Syva, EMIT, EMIT II, EMIT d.a.u., and all associated marks are trademarks of General Siemens Healthcare Diagnostics Inc. All Drugs other trademarks and brands are the Global Division property of their respective owners. of Abuse Siemens Healthcare Product availability may vary from Diagnostics Inc. country to country and is subject 1717 Deerfield Road to varying regulatory requirements. Deerfield, IL 60015-0778 Please contact your local USA representative for availability. www.siemens.com/diagnostics Siemens Global Headquarters Global Siemens Healthcare Headquarters Siemens AG Understanding Wittelsbacherplatz 2 Siemens AG 80333 Muenchen Healthcare Sector Germany Henkestrasse 127 Benzodiazephine Use, 91052 Erlangen Germany Abuse, and Detection Telephone: +49 9131 84 - 0 www.siemens.com/healthcare www.usa.siemens.com/diagnostics Answers for life. Order No. A91DX-0701526-UC1-4A00 | Printed in USA | © 2009 Siemens Healthcare Diagnostics Inc. Syva has been R1 R2 a leading developer N and manufacturer of AB R3 X N drugs-of-abuse tests R4 for more than 30 years. R2 C Now part of Siemens Healthcare ® Diagnostics, Syva boasts a long and Benzodiazepines have as their basic chemical structure successful track record in drugs-of-abuse a benzene ring fused to a seven-membered diazepine ring. testing, and leads the industry in the All important benzodiazepines contain a 5-aryl substituent ring (ring C) and a 1,4–diazepine ring.
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Risk Based Requirements for Medicines Handling
Risk based requirements for medicines handling Including requirements for Schedule 4 Restricted medicines Contents 1. Introduction 2 2. Summary of roles and responsibilities 3 3. Schedule 4 Restricted medicines 4 4. Medicines acquisition 4 5. Storage of medicines, including control of access to storage 4 5.1. Staff access to medicines storage areas 5 5.2. Storage of S4R medicines 5 5.3. Storage of S4R medicines for medical emergencies 6 5.4. Access to storage for S4R and S8 medicines 6 5.5. Pharmacy Department access, including after hours 7 5.6. After-hours access to S8 medicines in the Pharmacy Department 7 5.7. Storage of nitrous oxide 8 5.8. Management of patients’ own medicines 8 6. Distribution of medicines 9 6.1. Distribution outside Pharmacy Department operating hours 10 6.2. Distribution of S4R and S8 medicines 10 7. Administration of medicines to patients 11 7.1. Self-administration of scheduled medicines by patients 11 7.2. Administration of S8 medicines 11 8. Supply of medicines to patients 12 8.1. Supply of scheduled medicines to patients by health professionals other than pharmacists 12 9. Record keeping 13 9.1. General record keeping requirements for S4R medicines 13 9.2. Management of the distribution and archiving of S8 registers 14 9.3. Inventories of S4R medicines 14 9.4. Inventories of S8 medicines 15 10. Destruction and discards of S4R and S8 medicines 15 11. Management of oral liquid S4R and S8 medicines 16 12. Cannabis based products 17 13. Management of opioid pharmacotherapy 18 14.
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Benzodiazepines
Benzodiazepines Using benzodiazepines in Children and Adolescents Overview Benzodiazepines are group of medications used to treat several different conditions. Some examples of these medications include: lorazepam (Ativan®); clonazepam (Rivotril®); alprazolam (Xanax®) and oxazepam (Serax®). Other benzodiazepine medications are available, but are less commonly used in children and adolescents. What are benzodiazepines used for? Benzodiazepines may be used for the following conditions: • anxiety disorders: generalized anxiety disorder; social anxiety disorder; post-traumatic stress disorder (PTSD); panic attacks/disorder; excessive anxiety prior to surgery • sleep disorders: trouble sleeping (insomnia); waking up suddenly with great fear (night terrors); sleepwalking • seizure disorders (epilepsy) • alcohol withdrawal • treatment of periods of extreme slowing or excessive purposeless motor activity (catatonia) Your doctor may be using this medication for another reason. If you are unclear why this medication is being prescribed, please ask your doctor. How do benzodiazepines work? Benzodiazepines works by affecting the activity of the brain chemical (neurotransmitter) called GABA. By enhancing the action of GABA, benzodiazepines have a calming effect on parts of the brain that are too excitable. This in turn helps to manage anxiety, insomnia, and seizure disorders. How well do benzodiazepines work in children and adolescents? When used to treat anxiety disorders, benzodiazepines decrease symptoms such as nervousness, fear, and excessive worrying. Benzodiazepines may also help with the physical symptoms of anxiety, including fast or strong heart beat, trouble breathing, dizziness, shakiness, sweating, and restlessness. Typically, benzodiazepines are prescribed to manage anxiety symptoms that are uncomfortable, frightening or interfere with daily activities for a short period of time before conventional anti-anxiety treatments like cognitive-behavioural therapy or anti-anxiety takes effect.
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THE USE of MIRTAZAPINE AS a HYPNOTIC O Uso Da Mirtazapina Como Hipnótico Francisca Magalhães Scoralicka, Einstein Francisco Camargosa, Otávio Toledo Nóbregaa
ARTIGO ESPECIAL THE USE OF MIRTAZAPINE AS A HYPNOTIC O uso da mirtazapina como hipnótico Francisca Magalhães Scoralicka, Einstein Francisco Camargosa, Otávio Toledo Nóbregaa Prescription of approved hypnotics for insomnia decreased by more than 50%, whereas of antidepressive agents outstripped that of hypnotics. However, there is little data on their efficacy to treat insomnia, and many of these medications may be associated with known side effects. Antidepressants are associated with various effects on sleep patterns, depending on the intrinsic pharmacological properties of the active agent, such as degree of inhibition of serotonin or noradrenaline reuptake, effects on 5-HT1A and 5-HT2 receptors, action(s) at alpha-adrenoceptors, and/or histamine H1 sites. Mirtazapine is a noradrenergic and specific serotonergic antidepressive agent that acts by antagonizing alpha-2 adrenergic receptors and blocking 5-HT2 and 5-HT3 receptors. It has high affinity for histamine H1 receptors, low affinity for dopaminergic receptors, and lacks anticholinergic activity. In spite of these potential beneficial effects of mirtazapine on sleep, no placebo-controlled randomized clinical trials of ABSTRACT mirtazapine in primary insomniacs have been conducted. Mirtazapine was associated with improvements in sleep on normal sleepers and depressed patients. The most common side effects of mirtazapine, i.e. dry mouth, drowsiness, increased appetite and increased body weight, were mostly mild and transient. Considering its use in elderly people, this paper provides a revision about studies regarding mirtazapine for sleep disorders. KEYWORDS: sleep; antidepressive agents; sleep disorders; treatment� A prescrição de hipnóticos aprovados para insônia diminuiu em mais de 50%, enquanto de antidepressivos ultrapassou a dos primeiros.
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MEDICATION GUIDE Estazolam (Es-TAZE-Oh-Lam)
MEDICATION GUIDE Estazolam (es-TAZE-oh-lam) Tablets, C-IV What is the most important information I should know about estazolam? • Estazolam is a benzodiazepine medicine. Taking benzodiazepines with opioid medicines, alcohol, or other central nervous system depressants (including street drugs) can cause severe drowsiness, breathing problems (respiratory depression), coma and death. • After taking estazolam, you may get up out of bed while not being fully awake and do an activity that you do not know you are doing. The next morning, you may not remember that you did anything during the night. You have a higher chance for doing these activities if you drink alcohol or take other medicines that make you sleepy with estazolam. Reported activities include: ◦ driving a car ("sleep-driving") ◦ making and eating food ◦ talking on the phone ◦ having sex ◦ sleep-walking Call your healthcare provider right away if you find out that you have done any of the above activities after taking estazolam. • Do not take estazolam unless you are able to stay in bed a full night (7 to 8 hours) before you must be active again. • Do not take more estazolam than prescribed. What is estazolam? • Estazolam is a prescription medicine used short-term to treat certain types of insomnia including difficulty falling asleep, waking up often during the night, or waking up early in the morning. • Estazolam is a federal controlled substance (C-IV) because it can be abused or lead to dependence. Keep estazolam in a safe place to prevent misuse and abuse. Selling or giving away estazolam may harm others, and is against the law.
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XANAX® Alprazolam Tablets, USP
XANAX® alprazolam tablets, USP CIV WARNING: RISKS FROM CONCOMITANT USE WITH OPIOIDS Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death [see Warnings, Drug Interactions]. Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation. DESCRIPTION XANAX Tablets contain alprazolam which is a triazolo analog of the 1,4 benzodiazepine class of central nervous system-active compounds. The chemical name of alprazolam is 8-Chloro-1-methyl-6-phenyl-4H-s-triazolo [4,3-α] [1,4] benzodiazepine. The structural formula is represented to the right: Alprazolam is a white crystalline powder, which is soluble in methanol or ethanol but which has no appreciable solubility in water at physiological pH. Each XANAX Tablet, for oral administration, contains 0.25, 0.5, 1 or 2 mg of alprazolam. XANAX Tablets, 2 mg, are multi-scored and may be divided as shown below: 1 Reference ID: 4029640 Inactive ingredients: Cellulose, corn starch, docusate sodium, lactose, magnesium stearate, silicon dioxide and sodium benzoate. In addition, the 0.5 mg tablet contains FD&C Yellow No. 6 and the 1 mg tablet contains FD&C Blue No. 2. CLINICAL PHARMACOLOGY Pharmacodynamics CNS agents of the 1,4 benzodiazepine class presumably exert their effects by binding at stereo specific receptors at several sites within the central nervous system. Their exact mechanism of action is unknown. Clinically, all benzodiazepines cause a dose-related central nervous system depressant activity varying from mild impairment of task performance to hypnosis.
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