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alprazolam (Xanax), Benzodiazepines - Coggle Diagram
alprazolam (Xanax)
Warnings/Precautions/Contraindications
Anterograde Amnesia
CNS Depression
Sleep Related Activities
Aggressive Behavior
Contraindications: Acute narrow glaucoma, use with itraconazole or ketoconazole, hypersensitivity to benzodiazepines
Counseling
Avoid abrupt discontinuation of the drug
Avoid alcohol, grapefruit & grapefruit juice
Symptoms include: increased appetite, changes in weight, constipation, dizziness, dysarthria, memory impairment, somnolence, depression, or reduced libido
Monitor for confusion (especially in elderly patients)
PK/PD/PGX
Metabolized by CYP3A4
80% Protein Bound
Food decreases bioavailability
Adverse Drug Reactions
CNS: Sedation, Fatigue, Drowsiness
Dermatologic: Skin Rash
Metabolic
Monitoring
Reduction in symptoms of anxiety
Blood counts, urinalysis, and blood chemistry
Respiratory depression or sedation
Duration (goals, regimen, effect/toxicity, follow-up)
Titrate up if needed (MAX daily dose: 4 mg in divided doses). When discontinuing therapy, daily dose should be decreased by 0.5 mg every 3 days.
Toxicology: wide therapeutic window, but coma and respiratory depression can occur in large overdoses
Goals: remission of anxious symptoms
Interactions
CYP3A4 Inducers
Alcohol
Special Populations
Pregnancy/lactation
Pediatric
Determinants of Health
Price
Regimen: 0.25 to 0.5 mg orally 3x a day
Benzodiazepines
MOA: Bind to GABA A Receptors to decrease neuronal excitability
diazepam (Valium)
Adverse Drug Reactions
Cardiovascular: hypotension, vasodilation
Dermatologic: Skin rash
CNS:
Drowsiness,
Headache, euphoria
PK/PD/PGX
Bioavailability, oral: >90%
Delayed and decreased absorption when taken with food
95-99% protein binding
Metabolized by CYP3A4 and 2C19
Monitoring
CBC, liver function tests (periodically for long-term therapy)
Respiratory depression or sedation in patients taking opioids
Reduction in sx of anxiety
Regimen
For anxiety: 2 to 10 mg every 3 to 6 hours as needed up to 40 mg/day; adjust dose based on response and tolerability
Interactions
CYP2C19 inhibitors/inducers
CYP3A4 inhibitors/inducers
Alcohol/cannabis
other CNS depressants may result in sedation, respiratory depression, coma, and death
Education
Avoid activities requiring mental alertness/coordination until drug effects are realized
SE may include nausea and headache
Avoid sudden discontinuation due to potential for withdrawal sx
Warning/Contraindications
CNS Depression
Paradoxical Reactions: Hyperactive/aggressive behavior
Hazardous sleep-related activities: sleep walking/driving/cooking
Special Populations
potential fetal risk
caution in older adults
no dose adjustment in hepatic/renal impairment
lorazepam (Ativan)
3P
PD: 90% oral bioavailability
PGX
PK: half-life elimination between 12 and 18 hours
Adverse Drug Reactions/Allergies
Allergies
PEG, PPG, benzyl alcohol
hypersensitivity to benzodiazepines
ADR
drowsiness
dizziness
Monitoring
respiratory and cardiovascular
BP & HR
anxiety symptoms
long-term: CBC, LFTs, LDH
Regimen:
Acute Anxiety: 0.5 to 2 mg q 4-6 hours PRN; max 10 mg/day
Warnings/Precautions/Contraindications
Contraindications
severe respiratory insufficiency
acute narrow-angle glaucoma
hypersensitivity
Warnings
CNS depression
hyperactive/aggressive behavior
dangerous sleeping when doing other things (driving, cooking)
anterograde amnesia
BBW: benzos + opioids may result in sedation, respiratory depression, coma, death
Precautions
depressions may occur or be made worse when taking lorazepam
liver impairment
drug abuse
renal impairment
respiratory disease
Education/Counseling
Do not operate heavy machinery until you know how the medication affects your alertness
Do not consume with alcohol or other drugs that may make you drowzy
Keep in a safe place and take medication exactly as directed to prevent misuse and abuse
You may experience serious withdrawal symptoms if you stop taking the medication suddenly
Duration
usually used short-term (<12 weeks) but may be used long-term for specific patients
Interactions
alcohol
CNS depressants
fexinidazole
olanzapine
Special Populations
Pregnancy: avoid use during Pregnancy. Do not use while breastfeeding
Renal Impairment: No dosage adjustment necessary
Hepatic Impairment: use with caution
Geriatric: use with caution age >65 due to sedation and unsteadiness