Parallel Journal Article Summary

Xanax is a benzodiazepine that is most often used to treat anxiety. The effects of benzodiazepines mainly come from their ability to alter the movement of the inhibitory transmitter known as GABAa. GABA is triggered to release when it then can bind to the GABAa receptor. The binding of the two causes the ion channel to open and chloride ions are sent across the cell membrane. This causes the inhibitory factor by depolarizing the membrane (Griffin et al., 2013).

The study by Amato, Minozzi and Davoli (2011) examined five randomized controlled trials to find an efficient and safe medication to treat AWS. The study which had a total of 7333 patients concluded that benzodiazepines were better for controlling seizures when compared to a placebo and antipsychotics (Amato et al., 2011). When comparing benzodiazepines versus anticonvulsants, researchers concluded that the benzodiazepine chlordiazepoxide had better outcomes. No other studies were found which would compare the effectiveness among benzodiazepines for the treatment of AWS.

Olanzapine is associated with adverse effects when taken above the safe therapeutic range between 20 to 40 ng/ml, symptoms of toxicity include depression, tachycardia and hyperpryexia,, the effects of these symptoms are normally more severe in children.. Olanzapine is considered to have a low mortality rate although serious cases of olanzapine toxicity can lead to possible death. In postmortem examinations olanzapine is not normally the main cause of death, but is a contributing factor therefore the involvement of other drugs need to be considered. Early detection of toxicity is vital although activated charcoal has previously been beneficial in the treatment for an overdose of olanzapine (Chue, P., Singer, P., (2003)).

What drug is the antagonist and may be used to treat benzodiazepine overdose? What is the dosage in adults? Pediatric patients? What is the risk for complication with its use?

A variety of interventions such as anticonvulsants, benzodiazepines and combination therapies included were not considered in the economic analysis. Benzodiazepines is a drug that cannot be used longer than 2 to 4 weeks to treat anxiety. Clinical evidence on anticonvulsants and combination therapies had an overall low quality and was particular limited. Due to these reasons, the inclusion of these interventions in the analysis would not have significant implications for decision making. A significant limitation of the economic analysis was the poor quality of the recurrence of symptoms data used because of the lack of full bodied evidence of comparative risk of relapse between psychological and pharmacological interventions. Besides, the lack of intervention specific data, the economic model supposed one common risk of relapse employed to all pharmacological interventions and one common risk of relapse across all psychological ones. However, the evidence suggest that in contrast to pharmacological interventions, which has a relatively high relapse risk at six months of maintenance treatment, the psychological interventions is well maintained after end of treatment. Besides, for the economic model, the mean probabilities of

These drugs have the ability to reduce CNS activity causing the drug to promote fatigue which allows for a more productive sleep. Benzodiazepines that are intended to treat insomnia are classified as hypnotics. Some benzodiazepines are considered sedatives because they are prescribed to relax and calm patients which allows successful treatment for anxiety. Benzodiazepines are considered to substantially less dangerous than barbiturates because there are usually lower doses prescribed which lead to fewer instances of addiction. However, these drugs can be considered dangerous when they are combined with alcohol. Mixing barbiturates with alcohol can cause heightened and harmful

Anxiolytics are medications that decrease anxiety while hypnotics promote sleep. Some medications termed benzodiazepines are effective and used predominantly for anxiety but aid sleep due to having sedating properties. Benzodiazepine intended uses are for anxiety (general, panic, anticipatory and anxiety secondary to stress), sleep, side effects of other medications, agitation, alcohol and other sedative/hypnotic withdrawal and muscle spasms. Benzodiazepines include diazepam, lorazepam, clonazepam and alprazolam where all possess addictive properties. Other medications useful in treating anxiety without sedating properties include buspirone and D-cycloserine.

I enjoyed reading your post. Brett and Murnion (2015) recognizes the harm of benzodiazepine dependence; it is accounted for cognitive decline and falls in the elderly, not to mention, increased mortality and morbidity rate due to overdosing with these type of medication. I agree with Celso, these drugs are commonly used for insomnia and anxiety.

Treatment for aloprazalam drug toxicity consists of cardiac monitoring and oxygen. Naloxone can be administered at a lower dose with a gradual increase if needed to reverse respiratory depression which happens in most patients. Another treatment is the use of flumazenil which is the specific antidote for benzodiazepines. (Gershman, 2014). However, the use of this drug is controversial and does have some contraindications. It is contraindicated in patients with long-term benzodiazepines, patients who have ingested a substance that lowers the seizure threshold, or in patients who have tachycardia. The contraindications increase risk of seizures, cardiac arrest and possibly death. Because of the contraindications, most of the time flumazenil is not used for the treatment of benzodiazepine overdose. Although flumazenil is contraindicated and not used often, it can be very effective in reversing central nervous system depression associated with benzodiazepine toxicity but not effective in reversing respiratory depression. Flumazenil has a short half life of less than one hour and multiple doses may be needed for treatment. When flumazenil is used risk can be reduced by a slow dose titration of the drug

Both benzodiazepines and barbiturates are highly addictive and when prescribed the patient can become dependent, but benzodiazepines are much more worse and why it is only used in clinical areas under close surveillance. A new medication called buspirone (BuSpar), is used to help increase the efficiency of the bodies own emotion-regulating chemicals. This drug has by far many more advantages than other anxiolytics, it does not cause dependency, does not interact with alcohol and it does not affect the individual's ability to drive or operate heavy machinery (Narins, 2013). The downfall of long term medication is that it may cause can cause liver issues, dependency, and the price of medication in today's economy is

Sedative-hypnotics, including benzodiazepines, are a group of drugs used to treat the symptoms of anxiety, panic disorders, and insomnia.

If all these preventive strategies failed, prompt interventions to correct the condition and treat delirium should be initiated. In such cases, pharmacological treatments are often necessary. Haloperidol,a typical antipsychotic, is the most commonly used empiric agent in this regard, but the staff need to be very vigilant upon potential, significant side-effects of this medication, including extrapyramidal symptoms, torsades de points, prolongation of the Q-T interval, and neuroleptic malignant syndrome(12). Although the exact mechanism of action of this medication in treating delirium is unknown, it is thought that haloperidol acts through antagonizing brain dopamine-2 receptor and reducing dopaminergic activity at the cerebral synapses and basal ganglia(97, 109, 110). Initially, 2mg of the medication is administered intravenously. It could be repeated every 15-20 min, doubling the dose each time until agitation is resolved. After stabilizing the patient, the leasteffective dose should be used every 4-6h as the maintenance (11). Olanzapine (2.5-5 mg orally per day) and other atypical antipsychotics such asziprasidone (40 mg orally every 6-12h) and quetiapine (50 mg orally every 12h)have also been used in treating ICU delirium(11, 111-113). However, there is still controversy in this regard, because these drugs may increase death risk(111,

Benzodiazepines, otherwise known as benzos, are classified as medications that aid in certain disorders, such as anxiety, insomnia, panic attacks, and even loss of interest, among others.

The efficacy and safety of the drug in patients under the age of 18 years is not established. With renal / hepatic insufficiency and long-term treatment, control over the picture of peripheral blood and liver enzymes is necessary. Patients who did not take previously psychoactive drugs respond to the drug at lower doses compared to patients taking antidepressants, anxiolytics or alcohol. With endogenous depression, alprazolam can be used in combination with antidepressants. With the use of alprazolam, patients with depression have seen cases of hypomanic and manic development. Like other benzodiazepines, alprazolam has the ability to induce drug dependence in long-term admission in large doses (more than 4 mg / day). With a sudden discontinuation of alprazolam, there may be comeback syndromes, such as depression, irritability, insomnia, increased sweating, especially with prolonged admission (more than 8-12 weeks). When patients develop such unusual reactions as increased aggressiveness, acute excitations, feelings of fear, thoughts of suicide, hallucinations, increased muscle cramps, difficult sleep, superficial sleep, treatment should be discontinued. During pregnancy Xanax is very dangerous due to its toxic effect on the fetus and increases the risk of congenital malformations when applied in the first trimester of pregnancy. Admission of therapeutic doses in later periods

this is both retrospective and observational study of patients during the course of their psychiatric care in the inpatient and outpatient clinic. These patients exhibited Tardive dyskinesia, akathisia, parkinsonism while under treatment with Aripiprazole ,are included in this report. Data is collected from the structured clinical case record files and the experience of the treating psychiatrist. Patient carried a psychiatric diagnosis based on ICD-10 classificatory system. Various scales for movement disorder were used to record the severity and to establish the causality for adverse drug reaction. For brief review of literature, authors reviewed Pubmed, pubmed central[PMC], google scholar and other related articles on the subjects, using