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Related Concept Videos

Anxiolytic Drugs: Benzodiazepines and Buspirone01:29

Anxiolytic Drugs: Benzodiazepines and Buspirone

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Benzodiazepines are a class of anxiolytic drugs known for their rapid efficacy and high therapeutic-to-lethal dose ratio, but with a potential risk of drug dependence. These drugs are lipophilic, allowing for rapid absorption after oral administration, eventually reaching the central nervous system (CNS). Once in the CNS, benzodiazepines bind to the allosteric site of the GABAA receptor. This binding enhances the inhibitory effects of the neurotransmitter GABA. By doing so, they prevent...
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Sedatives and Hypnotics Drugs: Benzodiazepines01:19

Sedatives and Hypnotics Drugs: Benzodiazepines

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Benzodiazepines have both sedative and hypnotic properties. They include compounds such as diazepam (Valium) and alprazolam (Xanax). Structurally, their cores are similar, consisting of the fusion of a benzene ring and a diazepine ring, but they share a common mechanism of action in the central nervous system (CNS).
Benzodiazepines work by enhancing the effects of the inhibitory neurotransmitter GABA. They bind to the GABAA receptor, increasing its affinity for GABA, which opens chloride...
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CNS Depressants: Barbiturates and Benzodiazepines01:14

CNS Depressants: Barbiturates and Benzodiazepines

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CNS depressants include drugs from the category of barbiturates and benzodiazepines. They are valuable medications for managing anxiety disorders and insomnia. Barbiturates, once used to induce and maintain sleep, have been replaced mainly by benzodiazepines due to barbiturate's toxicity, tolerance, and overdose risks. They interact with GABAA receptors, leading to sedation at low doses and potentially coma and death at higher doses. Phenobarbital, a long-acting barbiturate, possesses...
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Anxiolytic Drugs: Overview01:26

Anxiolytic Drugs: Overview

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Anxiolytic drugs are vital in managing anxiety disorders by effectively alleviating symptoms such as excessive fear, tachycardia, and tremors. There are several classes of anxiolytic medications, each with unique mechanisms of action and potential side effects.
Primary Types of Anxiolytic Drugs
1. Benzodiazepines:
Benzodiazepines bind to the GABA-A receptor in the brain, enhancing GABA's interaction. This action reduces neurotransmission, effectively blocking anxiety-associated limbic...
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Sedatives and Hypnotics Drugs: Miscellaneous Agents01:17

Sedatives and Hypnotics Drugs: Miscellaneous Agents

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Sedatives and hypnotics encompass a wide range of substances, each with its unique mechanism of action, uses, and potential adverse effects.
Melatonin congeners like ramelteon (Rozerem) and tasimelteon (Hetlioz) selectively bind to melatonin receptors (MT1 and MT2) and thus mimic the actions of melatonin, a hormone that regulates sleep-wake cycles. Tasimelteon is primarily used for non-24-hour sleep-wake disorder, common in blind patients. They are also used to treat conditions like insomnia...
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Sedatives and Hypnotics: Overview01:23

Sedatives and Hypnotics: Overview

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Sedatives are drugs that alleviate anxiety, while hypnotics induce sleep. Both classes of medication suppress neuronal activity, leading to a calming effect for sedatives and facilitating sleep for hypnotics.
Sedative-hypnotics are categorized into barbiturates, benzodiazepines (BZDs), and non-benzodiazepines or Z-drugs. These drugs work by suppressing central nervous system activity, and this suppression is dose-dependent. Older sedative medications, like barbiturates, follow a linear curve in...
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Benzodiazepine Use Disorder: Common Questions and Answers.

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  • 1Wake Forest University School of Medicine Cabarrus Family Medicine Residency Program, Concord, North Carolina.

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Millions of adults misuse benzodiazepines, leading to adverse effects like sedation and falls. Deprescribing these drugs requires slow tapering and behavioral interventions for better outcomes.

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Area of Science:

  • Pharmacology
  • Geriatric Medicine
  • Public Health

Background:

  • Benzodiazepine use is widespread in the U.S., with over 30 million adults reporting use in the past year.
  • Misuse, defined as using medication contrary to a doctor's directions, accounts for 17.2% of all benzodiazepine use.
  • Family physicians grapple with balancing perceived patient benefits against known risks and limited evidence supporting benzodiazepine efficacy.

Purpose of the Study:

  • To review the risks associated with benzodiazepine use and misuse.
  • To discuss challenges in managing benzodiazepine prescriptions in primary care.
  • To outline strategies for the safe deprescribing of benzodiazepines.

Main Methods:

  • Literature review of adverse effects, risk factors, and withdrawal symptoms associated with benzodiazepines.
  • Examination of evidence for adjunctive treatments during withdrawal.
  • Analysis of deprescribing strategies, including tapering and behavioral interventions.

Main Results:

  • Benzodiazepines are linked to significant central nervous system adverse effects (sedation, confusion, memory loss, depression, falls, fractures, motor vehicle accidents).
  • Risk factors for adverse effects and misuse include substance use disorders, concurrent central nervous system medications, and specific diseases.
  • Chronic daily use, especially in older adults, increases risks of falls, fractures, hospitalizations, and mortality.
  • Withdrawal symptoms are common, prolonged, and can be mitigated by adjunctive treatments.
  • Individualized, slow tapering over extended periods is crucial for minimizing withdrawal intensity.
  • Behavioral interventions, such as cognitive behavior therapy, enhance deprescribing success.

Conclusions:

  • Benzodiazepine use presents substantial risks, particularly concerning misuse and adverse effects in older adults.
  • Effective deprescribing necessitates a patient-centered approach with gradual tapering and supportive behavioral therapies.
  • Further research and clinical guidelines are needed to optimize benzodiazepine management and deprescribing practices.