1. Get the Facts on Benzodiazepines Sedative Hypnotics Created by: Shannon N. Phifer

2. Sedative-hypnotics are a group of drugs that cause CNS depression. Benzodiazepines and barbiturates are the most commonly used agents in this class. Other agents include the nonbarbiturate nonbenzodiazepine sedative- hypnotics, such as buspirone, zolpidem, ethchlorvynol, glutethimide, chloral hydrate, meprobamate, methaqualone, methyprylon, carisoprodol, and gamma- hydroxybutyrate (GHB) and its analog gamma- butyrolactone (GBL). Most severe sedative-hypnotic poisonings are deliberate (suicidal). These agents are also commonly abused as recreational drugs. What are sedative hypnotics?

3. Types of Benzodiazepines  Klonopin (clonazepam))  Librium (chlordiazepoxide)  Valium (diazepam)  Ativan (lorazepam)  Doral (quazepam)  Halcion (triazolam)  Rohypnol (flunitrazepam) Benzodiazepines Benzodiazepines (BZDs) are sedative- hypnotic agents that were first introduced in 1960. BZDs commonly are used for a variety of situations that include seizure control, anxiety, alcohol withdraw, insomnia, control of drug-associated agitation, as muscle relaxants, and as pre-anesthetic agents. They also are combined frequently with other medications for procedural sedation. Because of their widespread use, these drugs have propensity for abuse. In addition, benzodiazepines frequently are used in overdose, either alone or in association with other substances. Benzodiazepines are classified as schedule IV depressants under the Controlled Substances Act. History and Examples

4.  Anxiolytic relief of anxiety - Anxiety and panic disorders, phobias  Hypnotic - promotion of sleep - Insomnia  Myorelaxant - muscle relaxation - Muscle spasms, spastic disorders  Anticonvulsant - stop fits, convulsions - Fits due to drug poisoning, some forms of epilepsy  Amnesia - impair short-term memory - Premedication for operations, sedation for minor surgical procedures  Other clinical uses, utilizing combined effects  Alcohol detoxification  Acute psychosis with hyper- excitability and aggressiveness Therapeutic Use of Benzodiazepines

5.  Dizziness or lightheadedness  Drowsiness  Change in personality and moodiness  Irritability, confusion  Blurred vision, headaches ***Benzodiazepines can only be obtained through a licensed physician. Always talk with your physician about any other medications (prescribed or herbal) you are taking. Serious interactions and risks can occur. Side Effects of Benzodiazepines

6.  Sleepiness and deep sleep  Slurred speech  Poor coordination and falling  Poor thought processes  Weak comprehension  Memory difficulty  Poor judgment  Mood swings  Involuntary jerking of the eyes  Constricted pupils  Slowed breathing rate  Addiction  Death if combined with alcohol  Possible overdose, leading to death Psychological Effects from Abuse

7.  BZD’s  Benzos  Downers  Nerve Pills  Tranks  Goofballs  Heavenly Blues  Qual  Robital  Stupefy  Tranx  Valley Girl (Valium) Common Street Names from Benzodiazepines

8. Benzodiazepine withdrawal is extremely challenging and uncomfortable, but rarely fatal. It is still best to have medical supervision as the addict tapers his or her dosage. Psychological symptoms include increased anxiety, panic attacks, rage, insomnia, nightmares, and depression. Physical symptoms include dizziness, shaking, nausea, constipation or diarrhea, headache, muscle pain, hyperactivity, sweating, altered heart rate, blurred vision, tingling or prickling sensation, and more. Seizures may occur if the benzodiazepines are stopped abruptly. Slow benzodiazepine tapering is usually necessary and withdrawal is most difficult for patients in the last half, when they are close to discontinuing the benzodiazepines. The severity of withdrawal from a short-acting benzodiazepine is greater than the withdrawal from a long-acting benzodiazepine. Withdrawal Effects from Benzodiazepines

9. Some of the symptoms that may occur as a result of long-term use of benzodiazepines include emotional clouding, nausea, headaches, dizziness, irritability, lethargy, sleep problems, memory impairment, personality changes, aggression, depression, agoraphobia, anxiety, and panic attacks, social deterioration as well as employment difficulties. While benzodiazepines are highly effective in the short term, adverse effects associated with long-term use including impaired cognitive abilities, memory problems, mood swings, and overdoses when combined with other drugs may make the risk-benefit ratio unfavorable. Please don’t wait until it is to late to get help! Detrimental Effects from Long-Term Benzodiazepine Use

10. UNITED STATES - ALCOHOL AND DRUG HELPLINE: National Toll-free number: 1-800-821-4357. Available 24 hours a day. Narconon DRUG REHAB HELPline 1-800-468-6933 Narcotics Anonymous 1-800-992-0401 Sometimes the hardest step is taking your first. All you may need is a helping hand to get you going. Helplines and Contact Information

11. Ashton, H. (2008). Therapeutic Use of and Side Effects of Benzodiazepines. University of New Castle, Department of Neurology, Neurobiology and Psychiatry. Retrieved October 17, 2012 from http://web4health.info/en/answers/bio-benzo-use.htm http://web4health.info/en/answers/bio-benzo-use.htm Addiction and Withdraw. In the Know Zone. Retrieved October 17, 2012 from http://www.intheknowzone.com/substance-abuse- topics/sedatives-tranquilizers-a-analgesics/addiction-and- withdrawal.html http://www.intheknowzone.com/substance-abuse- topics/sedatives-tranquilizers-a-analgesics/addiction-and- withdrawal.html Benzodiazepines. Office of Diversion Control. Retrieved October 16, 2012 http://www.deadiversion.usdoj.gov/drugs_concern/benzo_1.htm http://www.deadiversion.usdoj.gov/drugs_concern/benzo_1.htm References

12. List of Benzodiazepines. All Sleep. Retrieved October 16, 2012 from http://www.allsleep.com/sleep-aids/sleep-medicine/benzodiazepines/ http://www.allsleep.com/sleep-aids/sleep-medicine/benzodiazepines/ Sola, C., D.O. (2012). Sedative. Hypnotic, Anxiolytic Use Disorders Treatment and Management. Medscape Reference. Retrieved October 17, 2012 from http://emedicine.medscape.com/article/290585-treatmenthttp://emedicine.medscape.com/article/290585-treatment The Straight-Up Guide to Drugs, Addiction, Drug Abuse, and Treatment. The Good Drugs. Retrieved October 17, 2012 from http://www.thegooddrugsguide.com/ http://www.thegooddrugsguide.com/ References (continued)