Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Benzodiacepinas
Benzodiacepinas
GÍA DE LAS
BENZODIACE
Lorena Figueroa Buitrago y Diana Carolina
PINAS Libreros
HISTORIA DE LAS BENZODIACEPINAS
Siglo 19 1960
Bromuros Clordiazepóxi
do - Diazepam
Epileptic Disord
2016; 18 (3): 217-27
imidazo
PAMs. Propician los potenciales
postsinápticos fásicos. Usadas como
hipnóticos, ansiolíticos, anticríticos,
relajantes musculares y en el
tratamiento de la abstinencia a OH
Dubovsky SL, Marshall D. Benzodiazepines Remain Important Therapeutic Options in Psychiatric Practice.
Psychother Psychosom. 2022;91(5):307-334. doi: 10.1159/000524400. Epub 2022 May 3. PMID: 35504267.
Potencia
biotransformación
1. N-desalquilación (exc.
triazolam, alprazolam
y midazolam)
2. Hidroxilación
3. Conjugación con
ácido glucorónido
→ CYP3A4 y CYP2C19
GABA-AR y Gly-R.
Nasal, oral, IM, IV.
Indicaciones: Sedación
en paciente intubado, Lingamchetty TN, Hosseini
SA, Saadabadi A.
agitación, status Midazolam. [Updated 2023
convulsivo Feb 12]. In: StatPearls
[Internet]. Treasure Island
Ojo: anfipático según (FL): StatPearls Publishing;
2023 Jan-. Available from:
pH, alta tolerancia) https://www.ncbi.nlm.nih.g
ov/books/NBK537321/
PRESENTACIONES: triazolam 0.125-0.5 mg
Biodisponibilid Cmax Vida media Metabolismo Excreción Categoría
ad embarazo
Indicaciones:
Insomnio de
conciliación (uso
transitorio por máx 2
ss)
Capítulo 17. Hipnóticos y sedantes.». Goodman & Gilman. Las bases farmacológicas de la terapéutica. New York: McGraw-Hill.
PRESENTACIONES: alprazolam (0.25-5/10
Biodisponibilid Inicio de Vida mediamg)
Metabolismo Excreción Categoría
ad acción embarazo
George TT, Tripp J. Alprazolam. [Updated 2023 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK538165/
PRESENTACIONES: lorazepam (0.5-10 mg)
Biodisponibilida Cmáx Vida media Metabolismo Excreción
d
Indicaciones: trastorno
de ansiedad (4 m),
status convulsivo
(American Epilepsy
Society guidelines)
miorreajante, SNM,
abstinencia OH
PRESENTACIONES: mexazolam (1-3 mg)
Biodisponibilida Interacción Vida media Metabolismo Excreción
d especial
90% Estatinas Distribución bi- CYP3A4 y CYP2C11 90% fecal,
(excepto compartimental: 1 (chloronordiazepam y 10% renal
pravastatina) - 76 horas (larga) chloroxazepam+), unión a
proteínas 90%
Indicaciones: trastornos
de ansiedad
Dhaliwal JS, Rosani A, Saadabadi A. Diazepam. [Updated 2022 Sep 3]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
Tan KR, Rudolph U, Lüscher C. Hooked on
benzodiazepines: GABAA receptor subtypes
and addiction. Trends Neurosci. 2011
Apr;34(4):188-97. doi:
10.1016/j.tins.2011.01.004. Epub 2011 Feb 25.
PMID: 21353710; PMCID: PMC4020178
Epileptic Disord 2016; 18 (3):
217-27
contraindicaciones
Vademecum
Bounds CG, Nelson VL. Benzodiazepines. [Updated 2023 Jan 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470159/
Bounds CG, Nelson VL. Benzodiazepines.
[Updated 2023 Jan 7]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls
Publishing; 2023 Jan-. Available from:
Inhibidores
sEDANTES Inductores ugt
cyp3a4
Carbamazepina, Itraconazol,
fenobarbital, fenitoína ketoconazol, jugo de
y rifampizina toronja, claritromicina,
ritonavir.
“El uso conjunto con
dibenzodiacepinas tricícilicas (pinas:
clozapina, quetiapina y olanzapina)
aumenta el riesgo de sedación.”
—interacciones
EFECTOS
02 ADVERSOS
A corto plazo, largo plazo, demencia
EFECTOS
ADVERSOS
sedación
Enlentencimiento,
visión borrosa,
dificultad para hablar El uso de bzd
Caídas, durante más de 4
semanas, aumenta
fracturas el riesgo de
Pérdida del balance dependencia (30-
Cv Y 40%)
RESPIRATORI
Bradicardia,
AS
bradipnea
Dubovsky SL, Marshall D. Benzodiazepines Remain Important Therapeutic Options in Psychiatric Practice.
Psychother Psychosom. 2022;91(5):307-334. doi: 10.1159/000524400. Epub 2022 May 3. PMID: 35504267.
Definición de dependencia
Según CIE-10
- Un fuerte deseo o compulsión de
tomar la droga.
- Dificultades para controlar el uso
de drogas, síntomas de abstinencia,
evidencia de tolerancia, descuido
de placeres o intereses alternativos
- Uso persistente de drogas a pesar
de las consecuencias dañinas.
(DSM-IV): la dependencia está
presente por al menos 12 meses
Tan KR, Rudolph U, Lüscher C. Hooked on benzodiazepines: GABAA receptor subtypes and addiction.
Trends Neurosci. 2011 Apr;34(4):188-97. doi: 10.1016/j.tins.2011.01.004. Epub 2011 Feb 25. PMID:
21353710; PMCID: PMC4020178
Reacciones
paradójicas a las
benzodiacepinas
Extremos de edad, antecedentes de
agresividad. Alcohol, trastornos
afectivos y la demencia. Dosis más
altas de BZD, uso parenteral, fármacos
con t ½ corta y uso de anticolinérgicos.
¿Fisostigmina, flumazenil,
haloperidol?
Mancuso, C. E., Tanzi, M. G., & Gabay, M. (2004). Paradoxical Reactions to Benzodiazepines: Literature Review and Treatment Options. Pharmacotherapy, 24(9), 1177–1185.
Reddy, M. S. S., Achary, U., Harbishettar, V., Sivakumar, P. T., & Varghese, M. (2018). Paradoxical reaction to benzodiazepines in elderly – Case series. Asian Journal of
Dubovsky SL, Marshall D. Benzodiazepines Remain Important Therapeutic
Options in Psychiatric Practice. Psychother Psychosom. 2022;91(5):307-
334. doi: 10.1159/000524400. Epub 2022 May 3. PMID: 35504267.
Intoxicaci
ón
ABC - Flumazenil (NAM): dosis cada
30 seg 0.2 mg - 0.3 mg - 0.5 mg -
repetir cada minuto hasta dosis máxima
3-5 mg. Duración: 19-50 min.
Sharbaf Shoar N, Bistas KG, Saadabadi A. Flumazenil. [Updated 2023
May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2023 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK470180/
Benzodiacepinas y demencia
Ettcheto, M., Olloquequi, J., Sanchez-Lopez, E., Busquets, O., Cano, A., Manzine, P. R., ... & Camins, A. (2020). Benzodiazepines and related drugs as a risk factor in Alzheimer's disease dementia.
Frontiers in aging neuroscience, 11, 344.
Cohorte retrospectiva 2002
al 2015 de 268,170 adultos
> de 50 años
> 30 DDD de
benzodiacepinas, con un lag
libre de 5 años
Citation: Lee J, Jung SJ, Choi J-w, Shin A, Lee YJ (2018) Use of sedative-hypnotics and the risk of Alzheimer’s dementia: A retrospective cohort study. PLoS ONE 13(9): e0204413.
DHe, Q., Chen, X., Wu, T., Li, L., & Fei, X. (2019). Risk of dementia in long-term benzodiazepine users:
evidence from a meta-analysis of observational studies. Journal of Clinical Neurology (Seoul, Korea), 15(1), 9-
19.
Cómo descontinuar las benzodiacepinas
Anamnesis
01 completa
Valorar si es beneficioso
retirarlas. Tratar
comorbilidad.
02 titular a la baja
10-20% c/2 ss (4-8 ss). En el
hospital si dosis > 100 mg Apoyo no
diazepam
Vigilar 04 farmacológico
03 abstinencia
Mejora resultados (n = 189;
RR = 3.26; 95% CI = 2.36,
Mantener metadona/bupre*
4.51)
Soni, A., Thiyagarajan, A., & Reeve, J. (2023). Feasibility and effectiveness of deprescribing benzodiazepines and Z ‐drugs: systematic review
and meta‐analysis. Addiction, 118(1), 7-16.
Scrandis, D. A., & Duarte, A. C. (2019). Deprescribing benzodiazepines. The Nurse Practitioner, 44(2), 12-14.
Guina, J., & Merrill, B. (2018). Benzodiazepines II: waking up on sedatives: providing optimal care when inheriting benzodiazepine
prescriptions in transfer patients. Journal of clinical medicine, 7(2), 20.
Cloos, J. M., Lim Cow, C. Y. S., & Bocquet, V. (2021). Benzodiazepine high-doses: The need for an accurate
definition. International journal of methods in psychiatric research, 30(4), e1888.
https://doi.org/10.1002/mpr.1888
Físicos, sensoriales y
psicológicos
Soyka, M. (2017). Treatment of benzodiazepine dependence. New England Journal of Medicine, 376(12), 1147-1157.
MANEJO DE LOS SÍNTOMAS DE
ABSTINENCIA
—SOMEONE
FAMOUS
“This is a quote, words full of wisdom
that someone important said and can
make the reader get inspired.”
—SOMEONE
FAMOUS
EFECTOS ADVERSOS
VENUS SATURN
Venus has a beautiful Saturn is the only
name, but it’s hot planet with rings
MERCUR
MARS
Y
Mercury is the Despite being red,
closest planet to the Mars is a cold place
Sun
JUPITER NEPTUNE
It’s the biggest planet Neptune is the
in the Solar System farthest planet from
the Sun
WHO
A!
This can be the part of the presentation where
you can introduce yourself, write your email...
INTRODUCTI
ON
Mercury is the closest planet to the Sun
and the smallest one in the Solar System
—it’s only a bit larger than the Moon. It
was named after a Roman god
INTRODU
CTION
Mercury is the closest planet to the Sun and the
smallest one in the Solar System—it’s only a bit
larger than the Moon. It was named after a
Roman god
THE SLIDE TITLE GOES HERE!
● They’re simple
● You can organize your ideas clearly
● You’ll never forget to buy milk!
MERCURY VENUS
Mercury is the closest Venus has a beautiful name
planet to the Sun and the and is the second planet
smallest one in the Solar from the Sun. It’s terribly
System hot
MAYBE YOU NEED TO DIVIDE THE
CONTENT
Mercury Venus
Mercury is the closest Venus has a beautiful
planet to the Sun and the name and is the second
smallest one in the Solar planet from the Sun. It’s
System terribly hot
YOU can USE THREE COLUMNS, WHY
NOT?
MARS
Despite being red, Mars is actually
a cold place. It’s full of iron oxide
dust
SATURN
It’s a gas giant composed mostly of
hydrogen and helium
A PICTURE ALWAYS
REINFORCES THE
CONCEPT
Images reveal large amounts of
data, so remember: use an image
instead of a long text
A PICTURE IS
WORTH A
THOUSAND
WORDS
A PICTURE IS
WORTH A
THOUSAND WORDS
A PICTURE IS WORTH A
THOUSAND WORDS
AWESOME
WORDS
Key words are great for catching your
audience’s attention
AWES
OME
WORD
DO YOU NEED A GRAPH?
SURFACE
MASS DIAMETER
GRAVITY
(earths) (earths)
(earths)
MARS 8 9 10 11 12 13 14
Despite being red, Mars
is actually a cold place 15 16 17 18 19 20 21
SATURN 22 23 24 25 26 27 28
It’s a gas giant composed
mostly of hydrogen 29 30 31
THIS IS A MAP
MARS
Despite being red, Mars
is a cold place
MERCURY
Mercury is the closest
planet to the Sun
THIS IS A MAP
JUPITER
It’s a gas giant and
the biggest planet
MARS
Despite being red,
Mars is a cold place
SATURN
It’s a gas giant
made of hydrogen
A TIMELINE ALWAYS WORKS WELL
386,000 km
is the distance between Earth and the Moon
12,000
Mars is very cold
4,000
Jupiter is a big planet
3,000
Mercury is the first planet
500
Venus is extremely hot
OUR TEAM
MERCURY VENUS
Mercury is the closest Venus has a beautiful
planet to the Sun name, but it’s terribly hot
MARS JUPITER
Despite being red, Mars It’s the biggest planet in
is a cold place the Solar System
YOU can USE FOUR COLUMNS, WHY NOT?
80% 20%
Despite being red, Mercury is the closest
Mars is actually a cold planet to the Sun
place
Follow the link in the graph to modify its data and then
paste the new one here. For more info, click here
PROGRESS
SATUR JUPITE
N R
Saturn is the only Jupiter is the biggest
planet with rings planet in the System
MERCU
MARS
RY
Mercury is the closest Despite being red,
planet to the Sun Mars is a cold place
Follow the link in the graph to modify its data and then
paste the new one here. For more info, click here
INFOGRAPHICS MAKE YOUR IDEA
UNDERSTANDABLE
SATURN NEPTUNE
Saturn is the only Neptune is the farthest
planet with rings planet from the Sun
1 2 3
MARS JUPITER
Despite being red, It’s the biggest planet
Mars is a cold place of them all
MAYBE YOU NEED A diagram
MOUNTAINS
40% 60%
Despite being red, Mars is Mercury is the smallest
a cold place planet of them all
03
TITLE OF
THE
SECTION
You can enter a subtitle here
if you need it
03
TITLE OF THE
SECTION
You can enter a subtitle here if you need it
SOMETIMES, REVIEWING CONCEPTS IS A
GOOD IDEA
JUPITER NEPTUNE
It’s the biggest planet Neptune is the farthest
in the Solar System planet from the Sun
DESKTOP SOFTWARE
You can replace the image on the screen with your own work. Just
delete this one, add yours and center it properly
mockups
PHOTOS VECTORS
● Beautiful mountain forest landscape (I) ● Flat design winter landscape
● Beautiful mountain forest landscape (II) ● Flat infographic element collectio
● Beautiful natural landscape of mountain n
● Close up shot smiling aged man ● Mountains landscape with pine tr
● Portrait of stylish man holding face mask ees
● Front view of woman holding face mask ● Landscape mountains backgroun
d
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PHOTOS VECTORS
● Woman in nature at waterfall ● Welcome landing page template
● Low angle view stony mountain with landscape
● Beautiful young woman with blond hair ● Welcome landing page template
● Portrait of young brunette woman with landscape
ICON
● Mountaineering and climbing Ico
n Pack
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PHOTOS VECTORS
● Bright pop landscape design ● Hand drawn explorer with backpa
● Beautiful landscape with mountains ck background
● Beautiful natural landscape of mountain
● Woman exploring forest
● Man exploring forest
● Portrait of senior woman out for an advent
ure
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