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Diazepam
64%
93/145
Methadone
3%
4/145
Naloxone
4%
6/145
Varenicline
2%
3/145
Flumazenil
23%
33/145
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This patient is experiencing withdrawal symptoms and delirium tremens due to benzodiazepine withdrawal. The treatment for benzodiazepine withdrawal is to give a long-acting benzodiazepine, diazepam. Benzodiazepines are a class of psychoactive drugs used to treat anxiety, spasticity, status epilepticus, alcohol withdrawal, delirium tremens, night terrors, and sleep-walking. Benzodiazepines function by facilitating GABA(a) action through increasing the frequency of chloride channel opening and thus decreasing neuron firing. Short-acting benzodiazepines (triazolam, oxazepam, midazolam, and alprazolam) have a high potential for addiction and are the most likely to cause withdrawal symptoms. Long-acting benzodiazepines, such as diazepam and chlordiazepoxide, have a lower potential for withdrawal and are used to treat withdrawal symptoms. Benzodiazepines, when taken with alcohol or barbiturates, have an additive effect on CNS depression. Treatment for overdose of benzodiazepines is supportive or with flumazenil, a competitive GABA antagonist. Longo and Johnson review the risks of benzodiazepine therapy, such as withdrawal symptoms. Anxiety is the main withdrawal symptom when taken at therapeutic doses along with autonomic instability. When discontinuation occurs suddenly, seizures and delirium tremens can result. The degree of withdrawal symptoms depends on the length of use, type of benzodiazepines taken, and dosing. Nutt and Malizia review the molecular biology of the GABA(a) receptor, which is composed of five sub-units in a rosette formation that span the cellular membrane, allowing the movement of chloride ions across the cell membrane. When GABA acts on the receptor, it increases the permeability of chloride ions, which produces a hyperpolarization of the neuron resulting in an inhibitory state. Benzodiazepines bind at an allosteric position increasing the efficiency of GABA. Illustration A summarizes the mechanism of action of benzodiazepines. Incorrect Answers: Answer 2: Methadone is used to treat optiate withdrawal. Answer 3: Naloxone is used to treat opioid overdoses. Answer 4: Varenicline is used to assist in smoking cessation. Answer 5: Flumazenil can be used to treat benzodiazepine overdoses.
4.4
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