Benzodiazepines in afya

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Don't prescribe unless no alternative - have phrases prepared to refuse or give at lowest dose for shortest time
note why started and what problems caused
manage withdrawal slowly, carefully and with other active coping mechanisms to schedule agreed with patient

2-3% adults in UK take regularly - more female and older, esp if in care home

role in - acute arousal / anxiety / insomnia, alcohol withdrawal, epilepsy, anaesthesia
not for chronic insomnia, epilepsy, spasticity, anxiety

problem - as cause dependance, toxicity (synergistic with other drugs), abuse
confusion and falls esp in elderly

withdrawal - usually 3-7 days after stopping - agitation and insomnia
general - tremor, twitches, nausea, palpitations, aches, headache
(days) - insomnia, anxiety
(weeks) - panic attacks, depressed, poor concentration, irritable
serious - seizures, delirium, hallucinations, delusions, paranoia

longer acting drugs - withdrawal is longer but less severe
taper all drugs when withdrawing

for successful withdrawal
convert to longer acting drug and taper it
manage anxiety and insomnia with non-drug means and info
usually do at home (collect drug daily ??) but occ in hospital

Dependance
Physiological - develops tolerance and shows withdrawal Sx
BZD dependance syndrome - cluster of cognitive, behavioural and physiological
includes compulsion to use - drug seeking behaviour, usually with marked tolerance
high risk - other substance abuse / maladaptive personality (impulsive, anxiety, dependant)
if suspected - question pt - why do they want benzo / what happens if don't take / what other drugs used / how oftern do they take ?? consider withdrawal / toxicity ...  other drugs abused (IV ??)

Withdrawal
Must be agreed by pt
ask about pt experience of and feelings about drugs
give plenty of info
programme over months - reducing dose by 10% per week ?
?have formal signed contract

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