Pharmacy Case Studies

Pharmacy Case Studies-36
There may be an association between benzo­diazepine use and the risk of falls and/or hip fractures in the elderly.

There may be an association between benzo­diazepine use and the risk of falls and/or hip fractures in the elderly.

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It is now three days since the pharmacist dispensed his prescription and Mr AB has returned to the pharmacist because he claims he is still not able to sleep properly.[1], published by Pharmaceutical Press, highlights the main questions to be considered in managing Mr AB’s case.Because of pharmacokinetic changes of pro-nordiazepam molecules (e.g.diazepam) associated with ageing, the elderly may be at increased risk.Conversely, if a benzodiazepine is taken as an hypnotic, the duration of action should be restricted to the night, hence a compound with a short elimination half-life is preferred.Benzodiazepine agonists and other agonist ligands at the benzodiazepine site achieve their therapeutic effects by enhancing the actions of the inhibitory ­neurotransmitter gamma-aminobutyric acid (GABA) at its receptor.Diazepam is more reliably absorbed following oral rather than intramuscular administration. Diazepam appears to undergo entero­hepatic recirculation with a second plasma peak occurring four to six hours after initial administration. Diazepam is oxidised in the liver to active metabolites including desmethyldi­azepam (nordiazepam), which has a half-life of over 100 hours.Benzodiazepine oxidation may be impaired in patients with liver disease and in some elderly patients.For more information on the diagnosis and treatment of insomnia, please refer to ‘Sleep disorders: diagnosis’ and ‘Sleep disorders: treatment’.Insomnia is characterised by the incapacity to sleep and/or to remain asleep for a reasonable period, which may vary from individual to individual.clobazam, diazepam, lorazepam); sports injuries where muscle relaxation is required (e.g.diazepam) and as premedications prior to surgery (e.g. The benzodiazepines have a number of other uses, including management of alcohol withdrawal ­syndrome (e.g. for falling asleep), although longer ­duration of action may be desired (e.g.


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