Benzodiazepines: Txheej txheem cej luam thiab siv

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Qhov tseeb | Benzodiazepine Table | Mechanism | Siv | Cov teebmeem | Siv hauv Cov Neeg Laus | Cov tshuaj sib cuam tshuam Cev xeeb tub thiab pub niam mis | Kev rho tawm | Tus nqi

benzodiazepines yog dab tsi?

Cov tshuaj benzodiazepines yog ib chav kawm ntawm cov tshuaj uas ua haujlwm hauv lub hauv nruab nrab lub paj hlwb thiab siv rau ntau yam kev kho mob, xws li kev ntxhov siab, qaug dab peg, thiab kev tshem tawm cawv. Benzodiazepines tshwm sim ua haujlwm los ntawm kev thaiv cov hlab ntsha hauv lub hlwb thiab lwm qhov chaw hauv lub hauv nruab nrab paj hlwb.



Raws li chav kawm, benzodiazepines zoo ib yam li lawv ua haujlwm hauv lub hlwb tab sis muaj qhov sib txawv potencies thiab lub sijhawm ua haujlwm. Vim li no, qee qhov benzodiazepines ua haujlwm zoo dua li lwm tus hauv kev kho mob tshwj xeeb. Cov piv txwv ntawm benzodiazepines muaj xws li alprazolam (hom: Xanax), diazepam (hom: Valium) thiab lorazepam (hom: Ativan).

Feem ntau siv benzodiazepine:

  • rau pw tsaug zog
  • kom induce so thiab tsis nco txog cov txheej txheem kho mob los yog phais
  • txo kev ntxhov siab (anxiolytic)
  • kev ntxhov siab
  • kho lossis tiv thaiv qaug dab peg
  • Kev kho dej cawv tshem tawm
  • cov leeg relaxant

Benzodiazepines yog ib hom tshuaj loj thiab muaj keeb kwm ntev ntawm kev txhim kho, pib nrog thawj FDA-pom zoo nyob rau xyoo 1960, chloridazepoxide (Librium) thiab diazepam (Valium). Muaj ntau yam kev xaiv muaj nyob rau hauv chav kawm, thiab feem ntau benzodiazepines tam sim no muaj nyob rau hauv generic, ua rau lawv pheej yig heev.

Tag nrho cov tshuaj benzodiazepines tau teev tseg raws li DEA teem sij hawm IV tswj cov khoom . Raws li cov tshuaj tswj hwm, tag nrho cov benzodiazepines muaj peev xwm ua rau muaj kev tsim txom, kev quav tshuaj thiab kev sib txawv.

Yav dhau los, benzodiazepines, tshwj xeeb tshaj yog thaum siv los ua sedative-hypnotic rau pw tsaug zog, tau touted li kev nyab xeeb rau cov laus. barbiturates , uas tuaj yeem ua rau tuag taus ntau dhau, tshwj xeeb tshaj yog thaum ua ke nrog cawv. Cov tshuaj benzodiazepines noj ib leeg tsis tshua muaj feem cuam tshuam nrog kev ua kom tuag ntau dhau, tab sis thaum ua ke nrog lwm cov tshuaj sedatives lossis cawv, qhov kev pheej hmoo yuav nce ntxiv. Flumazenil yog benzodiazepine antagonist tshuaj tua kab mob uas tuaj yeem muab tso rau hauv qhov chaw kub ntxhov kom thim rov qab cov teebmeem ntawm benzodiazepine overdose.

Rooj 1 lis U.S. muaj thiab hom npe benzodiazepines, thiab lawv cov kev siv thiab lub sijhawm ua haujlwm. Ntau lub npe khoom lag luam tau raug txiav tawm los ntawm lawv cov tuam txhab; Txawm li cas los xij, sib npaug, tus nqi qis dua yog muaj rau cov hom no.

Hais txog : Generic Drugs - Muaj thiab Patent Status

Table 1: Common Benzodiazepines Muaj nyob rau hauv Teb Chaws Asmeskas

Lub Npe Hom Lub Npe Siv dav Ib nrab neej * (teev)
alprazolam Xanax , Xanax XR kev ntxhov siab , kev ntxhov siab Ib nrab-lub neej 6-26 h (short-acting)
chlordiazepoxide Librium kev ntxhov siab, cawv tshem tawm Ib nrab-lub neej 30-100 h (ntev-ua yeeb yam)
clobazam Onfi Lennox-Gastaut Syndrome ib nrab-lub neej 71-82 h (ntev-ua yeeb yam)
clonazepam Clonopin qaug dab peg, kev ntxhov siab , neuralgia (pab mob) Ib nrab-lub neej 20-50 h (ntev-ua yeeb yam)
clorazepate Tranxene kev ntxhov siab, tshem tawm cawv, kev qaug dab peg Ib nrab-lub neej 20-100 h (ntev-ua yeeb yam)
diazepam Muaj nuj nqis , Valtoco (nasal spray) kev ntxhov siab, sedation, tshem tawm cawv, nqaij spasm , qaug dab peg Ib nrab-lub neej 20-100 h (ntev-ua yeeb yam)
tshuaj estazolam ProSom (khoom tsis siv) insomnia (siv sij hawm luv luv) Ib nrab-lub neej 10-24 h (nruab nrab-ua yeeb yam)
flurazepam Dalmane (khoom tsis siv) insomnia (siv sij hawm luv luv) Ib nrab-lub neej 40-100 h (ntev-ua yeeb yam)
lorazepam Ativan ntxhov siab vim, insomnia (siv lub sij hawm luv luv), qaug dab peg, sedation Ib nrab-lub neej 10-20 h (nruab nrab-ua yeeb yam)
midazolam Nazilam (qhov ntswg qhov ntswg); Versed (brand discontinued) preoperative sedation ; General tshuaj loog induction; qaug dab peg ib nrab-lub neej 2.5 h (short-acting); mus txog 7.2 h (active metabolite)
oxazepam ua Serax (khoom tsis siv) kev ntxhov siab, tshem tawm cawv Ib nrab-lub neej 5-15 h (short-acting)
quazepam Doral insomnia (siv sij hawm luv luv) ib nrab-lub neej 39-73 h (ntev-ua yeeb yam)
remimazolam Byfavo Cov txheej txheem sedation kav ntev li 30 feeb lossis tsawg dua (cov neeg laus) ib nrab-lub neej 37 mus rau 53 feeb (short-acting)
temazepam Restoril insomnia (siv sij hawm luv luv) Ib nrab-lub neej 10-20 h (nruab nrab-ua yeeb yam)
triazolam Halcion insomnia (siv sij hawm luv luv) Ib nrab-lub neej 2-5 h (short-acting)

* Ib nrab-lub neej yog lub sij hawm nws yuav siv sij hawm ib nrab ntawm cov tshuaj kom tshem tawm ntawm lub cev. Qhov luv luv ntawm ib nrab-lub neej, cov tshuaj raug tshem tawm sai dua, thiab qhov kev cuam tshuam sai dua tuaj yeem txo qis.

benzodiazepines ua haujlwm li cas?

Benzodiazepines ua haujlwm nyob rau hauv lub hauv nruab nrab lub paj hlwb, xaiv nyob rau qee qhov chaw muaj protein nyob hauv lub hlwb hu ua GABA-A receptors. Muaj peb hom GABA (gamma-aminobutyric) receptors hauv lub hlwb: GABA-A, GABA-B, thiab GABA-C. GABA yog lub ntsiab inhibitory neurotransmitter nyob rau hauv lub paj hlwb (ib yam tshuaj uas pab los thaiv lub paj hlwb). GABA pab tswj kev txav, pom, kev ntxhov siab, thiab ntau lwm lub hlwb ua haujlwm.

Benzodiazepines qhib GABA-activated chloride channels thiab tso cai rau cov chloride ions nkag mus rau hauv neuron. Qhov kev txiav txim no tso cai rau cov neuron los ua qhov tsis zoo thiab tiv thaiv kev ntxhov siab, uas ua rau muaj ntau yam kev ntxhov siab, sedative, lossis kev tiv thaiv qaug dab peg pom nrog cov tshuaj no.

Feem ntau siv rau benzodiazepines

Cawv tshem tawm

Cawv tshem tawm raug kuaj pom nyob rau hauv tus neeg mob uas muaj keeb kwm ntawm kev siv cawv hnyav thiab ntev ntev thiab txo qis los yog ua tiav abstinence los ntawm cawv. Kev tshem tawm cawv ua rau muaj kev hloov hauv lub cev, xws li:

  • tshee los yog tshee
  • pw tsaug zog nyuaj
  • tsis meej pem
  • kev ntxhov siab
  • kev xav tsis thoob
  • qaug dab peg
  • delirium tremens

Cov tshuaj xws li benzodiazepines yog thawj kab kev kho mob rau kev tshem tawm cawv. Benzodiazepines txo cov tsos mob ntawm kev tshem tawm thiab tej zaum yuav cawm tau txoj sia rau tus neeg mob. Cov tshuaj nquag siv hauv pab pawg no suav nrog: chlordiazepoxide (ib phau ntawv) diazepam (Valium), thiab lorazepam (Ativan). Lorazepam (Ativan) lossis oxazepam (Serax) yuav nyiam rau cov neeg mob uas muaj lub siab tsis zoo xws li cirrhosis. Chlordiazepoxide, diazepam, thiab lorazepam tuaj yeem muab qhov ncauj, tso rau hauv, lossis intramuscularly. Oxazepam tej zaum yuav muaj txiaj ntsig tab sis tsuas yog muaj nyob ntawm qhov ncauj xwb.

Kev ntxhov siab

Kev ntxhov siab thiab kev txhawj xeeb yog ib qho teeb meem tshwm sim hauv cov neeg laus; Txawm li cas los xij, thaum mob ntev, tsis muaj kev txhawj xeeb yuav kav ntev li ntawm rau lub hlis lossis ntev dua thiab cuam tshuam nrog kev ua ub no niaj hnub, qhov no yuav raug kuaj pom tias yog Generalized ntxhov siab vim (GAD). GAD yog qhov kev ntxhov siab ntau tshaj plaws, cuam tshuam rau 6.8 lab tus neeg laus lossis kwv yees li 3% ntawm cov neeg Asmeskas, tab sis ntau dua ib nrab tseem tsis tau kho. Nws tuaj yeem tshwm sim heev hauv cov neeg mob laus.

Cov tsos mob ntawm GAD muaj xws li:

  • Kev ntxhov siab ntau dhau rau tsawg kawg yog rau lub hlis TSIS yog vim muaj lwm yam mob hlwb, tshuaj noj, lossis tshuaj yeeb tshuaj
  • pw tsaug zog cuam tshuam, insomnia
  • qaug zog
  • kev ntxhov siab
  • nyuaj siab
  • chim siab
  • leeg nro

Kev kho tshuaj yuav nyob ntawm qhov kev ntxhov siab, tus neeg mob tus yam ntxwv xws li hnub nyoog thiab lub cev ua haujlwm, thiab tus neeg mob nyiam. Rau cov neeg mob uas tsis xav siv tshuaj, kev paub txog kev coj tus cwj pwm thiab kev kho kom zoo tau pom tias muaj txiaj ntsig zoo; Txawm li cas los xij, kev sib xyaw ua ke tuaj yeem ua haujlwm zoo tshaj plaws. Kev tawm dag zog txhua hnub tau pom tias yuav pab tau rau ntau tus neeg mob uas muaj kev ntxhov siab.

Antidepressants (SSRIs/SNRIs) raug suav hais tias yog thawj kab kev kho mob rau cov neeg mob feem ntau, thiab benzodiazepines tuaj yeem ua lub luag haujlwm ntxiv hauv kev kho GAD los daws cov tsos mob hnyav thaum cov tshuaj tiv thaiv kev ntxhov siab siv tau. Tsuas yog siv sijhawm luv luv ntawm cov tshuaj benzodiazepines qis (2 mus rau 6 lub lis piam) raug pom zoo, nrog qeeb, maj mam tapering ib zaug cov nyhuv antidepressant tuav. Kev txhawj xeeb txog kev pheej hmoo ntawm kev kam rau siab, kev vam khom, thiab kev hloov pauv nrog benzodiazepines txwv lawv cov txiaj ntsig hauv GAD. Benzodiazepines yuav tsum tau zam nyob rau hauv cov neeg mob uas muaj keeb kwm ntawm kev siv tshuaj.

Feem ntau benzodiazepines siv rau GAD suav nrog alprazolam , clonazepam , diazepam , thiab lorazepam . Mirtazapine ( Remeron ) thiab tshuaj buspirone (Buspar; brand discontinued) kuj muaj txiaj ntsig zoo hauv GAD rau cov neeg mob uas tsis teb rau tsawg kawg ob qhov kev sim ntawm SSRIs lossis SNRIs. Kev siv ntev ntev ntawm benzodiazepines rau GAD yuav tsum zam, thaum ua tau, vim muaj kev pheej hmoo ntxiv.

Benzodiazepines yuav tsum tau siv nrog ceev faj heev nyob rau hauv cov neeg laus vim muaj kev pheej hmoo rau ntau sedation, tsis meej pem, ntog thiab puas.

Insomnia

benzodiazepine hypnotics txo lub sij hawm nws yuav siv sij hawm kom tsaug zog thiab ntev lub sij hawm pw tsaug zog. Qhov sib txawv tseem ceeb muaj nyob rau ntev npaum li cas lawv tuaj yeem nyob hauv lub cev, tej zaum yuav ua rau muaj kev phiv ntev. Piv txwv li, lorazepam muaj lub sijhawm luv luv dua li diazepam, tso cai kom tshem tawm cov tshuaj sai dua thiab muaj kev cuam tshuam tsawg dua. Ntawm qhov tod tes, diazepam tuaj yeem nyob twj ywm hauv lub cev rau hnub thiab txhawb kev pheej hmoo rau cov kev mob tshwm sim ntev, tshwj xeeb tshaj yog cov neeg laus.

  • Benzodiazepines yuav tsum tau siv rau lub sijhawm luv luv (feem ntau 2 mus rau 4 lub lis piam) rau insomnia .
  • Cov tshuaj benzodiazepines luv luv feem ntau nyiam rau insomnia vim tias lawv theoretically tsim tsawg dua hnub tom ntej, txawm tias ntau tus neeg mob tseem ntsib cov teebmeem no.
  • Feem ntau, cov neeg mob yuav tsum rov ntsuam xyuas lawv tus cwj pwm pw tsaug zog - tsis txhob muaj caffeine thaum nruab hnub, txwv cov khoom siv hluav taws xob (TV, computer, mobile devices) hauv chav pw thiab hauv 1-2 teev ua ntej pw, thiab tsis txhob haus cawv thaum yav tsaus ntuj.
  • Kev tawm dag zog thaum ntxov tuaj yeem pab txhawb kev pw tsaug zog ntau dua; Txawm li cas los xij, kev tawm dag zog yav tsaus ntuj tuaj yeem txhawb nqa thiab muaj txiaj ntsig zoo.

Cov benzodiazepines uas thawj zaug FDA pom zoo rau insomnia, xws li temazepam (Restoril) los yog triazolam (Halcion), tsis siv ntau niaj hnub no vim muaj cov tshuaj tshiab uas tsis yog benzodiazepine, xws li eszopiclone ( Lunesta ), zolpidem ua ( Ambien ), los yog zaleplon ( Sonata ). Tag nrho cov tshuaj nonbenzodiazepine tau pom zoo tsuas yog rau kev kho mob insomnia.

Hais txog : Insomnia Treatment: Tsis yog Benzodiazepines Ambien, Lunesta thiab Sonata

Cov leeg nqaij relaxant

Cov skeletal leeg relaxant chav kawm, uas suav nrog cov neeg sawv cev xws li baclofen, carisoprodol (Soma), methocarbamol (Robaxin), metaxalone (Skelaxin), thiab cyclobenzaprine ( Amrix ), feem ntau yog siv cov kab thawj zaug thaum xav tau cov leeg nqaij. Benzodiazepines xws li diazepam kuj tseem siv tau luv luv los ua cov leeg nqaij.

Cov no feem ntau yog siv los txo cov mob pob txha pob txha pob txha, xws li qhov tshwm sim uas tshwm sim nrog mob sab nraub qaum leeg. Lawv tau ntxiv los ua ib qho ntxiv rau kev so, kev kho lub cev thiab / lossis kub thiab dej khov.

Panic mob

Panic disorder yog ib hom kev ntxhov siab tshwj xeeb. Hauv Tebchaws Meskas, kwv yees li 6 lab tus neeg laus, lossis 2.7% ntawm cov pejxeem raug cuam tshuam. Ib tug neeg nrog kev ntxhov siab muaj kev ntshai tawm tsam uas yog rov ua ntu zus ntawm kev ntshai hnyav uas tej zaum yuav xav tau lossis npaj txhij txog. Cov tsos mob no tuaj yeem nrog cov tsos mob ntawm lub cev uas zoo ib yam li lub cev lub cev ua rau muaj kev phom sij, feem ntau hu ua 'sib ntaus lossis ya' tshwm sim. Kev ntxhov siab tuaj yeem nrog rau lwm yam kev puas siab puas ntsws xws li kev nyuaj siab, kev ntxhov siab lossis kev quav yeeb tshuaj.

Cov tsos mob yuav muaj xws li:

  • ceev lub plawv dhia
  • trembling los yog tingling hnov
  • dej, liab thiab tawm hws
  • ua tsis taus pa
  • kev ntshai thiab kev paub ntau ntxiv ntawm ib puag ncig, txawm tias tsis muaj kev phom sij
  • txhawj txog kev tuag lossis poob tswj
  • kev zam ntawm cov neeg coob coob lossis lwm qhov chaw pej xeem vim kev ntshai ntawm kev tawm tsam (agoraphobia).

Panic disorder tuaj yeem yog qhov mob ntev, mob ntev, tab sis nws kho tau zoo nrog cov tshuaj uas txo cov tsos mob. Kev coj cwj pwm kev kho mob thiab kev kho mob nrog cov tshuaj tiv thaiv kev nyuaj siab xws li xaiv serotonin-reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), thiab/lossis kev coj tus cwj pwm yog kev kho thawj kab.

Cov laus tricyclic antidepressants , xws li nortriptyline (Pamelor) thiab imipramine (Tofranil) yog qhov zoo, thiab, tab sis tej zaum yuav cuam tshuam los ntawm kev qaug zog thiabCov tshuaj anticholinergic tshuaj phiv, uas tuaj yeem ua teeb meem tshwj xeeb rau cov neeg mob laus. Hauv cov uas tsis muaj kev sib koom ua ke xws li kev nyuaj siab lossis keeb kwm ntawm kev quav yeeb tshuaj, benzodiazepines yuav siv tau ceev faj rau lub sijhawm luv luv.

Kawm ntxiv : Kev ntxhov siab thiab ceeb ntshai: Cov tsos mob thiab kev kho mob

Benzodiazepines tuaj yeem siv thaum pib ntawm kev kho mob kom txo qis cov tsos mob thaum cov tshuaj tiv thaiv kev ntxhov siab tshwm sim, uas yuav siv li 4 mus rau 6 lub lis piam. Cov tshuaj benzodiazepines xws li clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium) thiab alprazolam (Xanax) muaj txiaj ntsig zoo rau kev tawm tsam. Lawv muaj kev nyab xeeb thaum siv raws li cov lus qhia thiab feem ntau nqa sai sai los ntawm cov tsos mob txaus ntshai.

Thaum txiav tawm, benzodiazepines yuav tsum tau maj mam tapered kom tsis txhob tshem tawm cov tsos mob xws li rebound insomnia thiab ntxhov siab vim. Thawj qhov tsis zoo ntawm benzodiazepines yog qhov pheej hmoo ntawm kev tsim txom thiab kev vam khom. Kev xaiv cov tshuaj kho mob yuav tsum yog raws li cov teeb meem ntawm kev noj tshuaj, qhov tshwm sim tshwm sim lossis kev cuam tshuam ntawm cov tshuaj, thiab tus nqi.

Procedural sedation (tseem hu ua conscious sedation)

Cov txheej txheem sedationyog kev siv cov tshuaj ua ke los pab tus neeg mob so (sedative) thiab thaiv qhov mob (tso tshuaj loog) thaum lub sij hawm kho mob lossis kho hniav. Benzodiazepines xws li diazepam lossis midazolam (Versed: brand discontinued)) feem ntau siv.

Thaum Lub Xya Hli 2020, remimazolam besylate (Byfavo) tau pom zoo los ntawm FDA rau kev txhawb nqa thiab kev saib xyuas cov txheej txheem sedation hauv cov neeg laus ua cov txheej txheem kav ntev li 30 feeb lossis tsawg dua.

Txoj kev sedation no yog ib qho kev phais rau tus neeg mob sab nraud lossis cov txheej txheem uas tso cai rau tus neeg mob rov qab los tsev tib hnub, piv txwv li, endoscopy lossis colonoscopy cov txheej txheem, kev txawj ntse hniav extractions, biopsies, thiab cov txheej txheem phais tsis yooj yim ntev dua li ib teev.

Ib txwm tsis tas yuav pab ua pa hauv kev nco qab sedation; Txawm li cas los xij, qhov tob tob ntawm sedation yuav tsis tshua tshwm sim, yog li cov cuab yeej ua pa thiab resuscitative yuav tsum muaj rau cov kws kho mob.

  • Cov benzodiazepines feem ntau siv rau cov txheej txheem sedation yog cais los ntawm lawv qhov ntev ntawm kev txiav txim: diazepam yog suav tias yog qhov ua yeeb yam ntev tshaj plaws thiab midazolam yog luv luv. Tsis txhob muab cov tshuaj analgesia (mob-relieving) cov khoom.
  • Midazolam nquag siv rau cov txheej txheem uas yuav tsum tau siv sijhawm tsawg dua ib teev, thiab tuaj yeem ua ke nrog opiate fentanyl rau kev tswj qhov mob.
  • Hauv cov neeg laus lossis cov neeg mob rog, lossis cov neeg uas muaj lub siab tsis zoo, cov nyhuv sedative yuav ntev.

Tus neeg mob yuav nyob twj ywm tab sis sedated, thiab feem ntau tsis nco qab txog cov txheej txheem. Cov neeg mob feem ntau tuaj yeem teb cov lus hais los yog cov lus txib tactile. Hom sedation no tso cai rau tus neeg mob kom rov zoo sai dua los ntawm kev siv tshuaj loog. Lawv yuav xav tau ib tus neeg tsav tsheb mus tsev thiab feem ntau tsaug zog mus txog hnub tom qab, yog li yuav tsum tau so haujlwm ib hnub.

qaug dab peg

Benzodiazepines feem ntau siv rau kev kho mob qaug dab peg - piv txwv suav nrog:

Rau ntau hom mob hnyav lossis ntev qaug dab peg los yogxwm txheej epilepticus, ib txoj hlab ntshav (IV) lossis qhov quav benzodiazepine yuav yog kev kho mob thawj zaug.

Tus kab mob epilepticus yog suav tias yog ib qho kev kho mob xwm txheej ceev uas muaj ntau tshaj 30 feeb ntawm kev qaug dab peg tas li; los yog muaj ob lossis ntau qhov qaug dab peg tsis tau rov qab los ntawm kev nco qab tag nrho ntawm ob qhov qaug dab peg.

  • Intravenous lorazepam yog suav tias yog thawj txoj kev kho mob ntawm ntau tus kws kho mob.
  • Diazepam yog muaj nyob rau hauv lub qhov quav gel rau cov neeg mob uas tsis tau nkag mus rau IV kab.
  • Midazolam feem ntau xaiv rau intramuscular (IM) lossis kho qhov ncauj.

Clonazepam yog benzodiazepine feem ntau siv rau kev tswj xyuas mus sij hawm ntev thiab tiv thaiv kev qaug dab peg ntev; Txawm li cas los xij, feem ntau benzodiazepines tsis yog thawj qhov kev xaiv rau kev tiv thaiv qaug dab peg.

  • Benzodiazepines tsis tsim nyog rau kev tswj hwm mus sij hawm ntev ntawm kev qaug dab peg vim yog kev txhim kho ntawm kev ua siab ntev ntawm cov neeg mob ntau.
  • Ntau hom tsoos ntau yam kev kho mob qaug dab peg (piv txwv li: carbamazepine, oxcarbazepine, levetiracetam, phenytoin, valproic acid, topiramate, lamotrigine) yuav raug siv thawj kab, nyob ntawm tus neeg mob tus yam ntxwv thiab kev kuaj mob vwm.

Lennox-Gastaut Syndrome yog ib hom mob qaug dab peg uas feem ntau pib thaum yau thiab tseem ua rau muaj teeb meem kev loj hlob thiab kev coj cwj pwm .. Clobazam (Onfi) yog siv los ua ib qho add-on (adjunct) benzodiazepine anticonvulsive kev kho mob nrog lwm cov tshuaj qaug dab peg hauv kev kho mob Lennox-Gastaut syndrome.

Nazilam (midazolam) thiab Valtoco (diazepam) yog tshuaj tsuag qhov ntswg tam sim no tau pom zoo rau kev kho mob qaug dab peg (tseem hu ua mob qaug dab peg). Nayzilam tau pom zoo los ntawm FDA los siv rau cov neeg mob hnub nyoog 12 xyoos thiab laus dua, thiab Valtoco siv rau cov 6 xyoo thiab laus dua.

Cov kev phiv tshwm sim ntawm benzodiazepines

Drowsiness, tsaug zog, los yog kiv taub hau yog feem ntau tshaj tawm cov kev mob tshwm sim nrog cov tshuaj no. Kev tsav tsheb lossis kev ua haujlwm ntawm lub tshuab lossis ua lwm yam haujlwm txaus ntshai tuaj yeem ua rau muaj kev phom sij thaum siv cov tshuaj no. Kev haus dej cawv ua ke nrog benzodiazepines tuaj yeem ua rau cov teebmeem no.

Kev pw tsaug zog tsis zoo thiab anterograde amnesia Tej zaum yuav tshwm sim nrog cov tshuaj benzodiazepines. Anterograde amnesia yog qhov poob ntawm lub peev xwm los tsim cov kev nco tshiab, ua rau ib feem lossis ua tiav tsis muaj peev xwm rov nco qab yav dhau los tsis ntev los no. Ob peb benzodiazepines paub tias muaj cov nyhuv amnesic haib; Triazolam (Halcion) muaj npe nrov.

Hnub tom qab tsaug zog thiab 'hangover effect' yog ib qho kev txhawj xeeb nrog benzodiazepines uas muaj lub sijhawm ntev, piv txwv li, nrog diazepam lossis flurazepam. Cov kev mob tshwm sim sedative tuaj yeem nqa mus rau hnub tom ntej thiab cuam tshuam kev tsav tsheb thiab lwm yam haujlwm txhua hnub; qhov no yog qhov tshwj xeeb txog kev pheej hmoo ntawm cov neeg laus.

Kev tshawb fawb tsis ntev los no yog tsom rau qhov ua tau cuam ​​tshuam rau kev paub (kev xav thiab kev xav muaj peev xwm) hauv cov neeg mob uas siv benzodiazepines rau lub sijhawm ntev. Hauv qee cov neeg mob, kev ua xua hnyav xws li anaphylaxis thiab angioedema tau tshaj tawm nrog benzodiazepines.

Hais txog : Cov teebmeem ntawm Benzodiazepines

Zuag qhia tag nrho, benzodiazepines yuav tsum tau siv lub sijhawm luv luv vim tias lawv tuaj yeem ua rau ua siab ntev, dependence (addiction) thiab kev tsim txom .

  • Muaj peev xwm benzodiazepines nrog luv luv tshem tawm ib nrab-lub neej (triazolam, alprazolam, lorazepam) tej zaum yuav ua rau muaj teeb meem nrog kev ua siab ntev thiab kev vam khom.
  • Kev rho tawm kuj tuaj yeem tshwm sim yog tias cov tshuaj nres tam sim ntawd, tshwj xeeb tshaj yog cov uas ua haujlwm luv dua.
  • Sudden discontinuation tuaj yeem ua rau rov qab insomnia, ua rau pw tsaug zog nyuaj, thiab ua rau kev siv txuas ntxiv thiab ntau dua ntawm cov tshuaj benzodiazepines.
  • Kev txiav tawm ntawm benzodiazepine yuav tsum maj mam ua raws li kws kho mob cov lus qhia.

Intravenous (IV) benzodiazepines tuaj yeem cuam tshuam nrog kev mob plawv thiab / lossis ua pa nres yog tias lawv tau txais sai heev. Lwm cov tshuaj tiv thaiv vim yog kev tswj hwm IV yuav suav nrog:

  • hypotension (tsis muaj ntshav siab)
  • cardiac arrhythmias (txawv lub plawv dhia)
  • qeeb lub plawv dhia
  • apnea (ua tsis taus pa ib ntus, tshwj xeeb tshaj yog thaum pw tsaug zog)
  • ua pa nyuaj siab (ua pa qeeb)
  • xeev siab / ntuav
  • qhov muag tsis pom kev los yog ob qhov muag pom
  • daim tawv nqaij ua pob
  • qhov chaw txhaj tshuaj

Siv hauv Cov Neeg Laus

Qee cov tshuaj benzodiazepines (diazepam, chlordiazepoxide) muaj cov tshuaj metabolites uas tseem nyob hauv lub cev rau lub sijhawm ntev (ua haujlwm ntev), thiab qhov no tuaj yeem ua teeb meem rau cov neeg mob, tshwj xeeb tshaj yog cov neeg laus. Cov neeg laus yuav muaj lub siab tsis zoo thiab teeb meem tshem tawm cov tshuaj los ntawm lawv lub cev. Cov kev mob tshwm sim, xws li kiv taub hau, tsis meej pem lossis tsis khov kho tuaj yeem tshwm sim hauv cov neeg laus uas tau muab tshuaj benzodiazepines ntev ntev.

Hauv cov neeg laus, benzodiazepines thiab nonbenzodiazepine cov neeg ua haujlwm yuav tsum raug zam, raws li kev pom zoo los ntawm cov kws kho mob. Beers Cov Cai , tus kws tshaj lij kev xav-tsim cov lus qhia hais txog kev siv tshuaj nyab xeeb rau cov neeg laus.

  • Cov neeg laus tau nce rhiab heev thiab txo cov metabolism hauv cov tshuaj no.
  • Cov tshuaj nonbenzodiazepine xws li eszopiclone, zaleplon, thiab zolpidem (cov tshuaj 'Z-tshuaj') muaj cov xwm txheej tsis zoo xws li cov benzodiazepines hauv cov neeg laus, xws li delirium, ntog thiab pob txha, tab sis ua rau kev txhim kho tsawg kawg ntawm kev pw tsaug zog.
  • Cov tshuaj no tuaj yeem ua rau muaj kev mus ntsib chav xwm txheej ceev, mus pw hauv tsev kho mob, thiab tsheb sib tsoo, thiab kev siv lawv yuav tsum zam rau cov neeg mob laus, raws li Beers cov qauv.

Yog tias muaj cov ntaub ntawv xav tau, koob tshuaj tsawg thiab tshuaj nrog lub sijhawm luv (ib nrab-lub neej) yuav pab txo qis cov kev mob tshwm sim xws li kiv taub hau, tsis muaj zog, thiab ntog uas yuav ua rau pob txha pob txha. Nyob rau hauv kev saib xyuas ntawm tus kws kho mob, tej zaum yuav tsim nyog siv benzodiazepines rau cov neeg laus, xws li rau qaug dab peg, qee yam kev pw tsaug zog tsis zoo, benzodiazepine los yog cawv tshem tawm, ntxhov siab heev, kev siv tshuaj loog, thiab kev kho mob thaum kawg.

Cov tshuaj sib cuam tshuam nrog benzodiazepines

Tseem ceeb : Ntau yam tshuaj sib cuam tshuam tuaj yeem tshwm sim nrog benzodiazepines; yog li ntawd, a tshuaj tiv thaiv tshuaj ntsuam ua tiav los ntawm tus kws kho mob yog ib kauj ruam tseem ceeb txhua lub sij hawm muaj tshuaj tshiab ntxiv lossis txiav tawm nyob rau hauv tej kev kho mob regimen.

Cov tshuaj benzodiazepines tuaj yeem cuam tshuam nrog kev noj ntau dhau thiab ua rau tuag taus thaum ua ke nrog cawv, opioids, lwm yam tshuaj sedatives, lossis tshuaj txhaum cai. Txawm hais tias nws tsis tshua muaj qhov overdose ntawm benzodiazepines los ntawm nws tus kheej yuav ua rau tuag taus, thaum ua ke nrog lwm cov tshuaj uas ua rau lub hauv paus paj hlwb, qhov kev pheej hmoo yuav nce ntxiv.

Piv txwv ntawm lwm cov tshuaj uas tej zaum yuav ntxiv rau lub hauv paus paj hlwb kev nyuaj siab yog ua ke nrog benzodiazepine muaj xws li:

  • phenothiazines
  • tshuaj opioids
  • barbiturates
  • Monoamine oxidase (MAO) inhibitors
  • tshuaj tiv thaiv kev nyuaj siab
  • cawv
  • tshuaj txhaum cai zoo li heroin (ib qho opiate)

Kev siv cov tshuaj benzodiazepines thiab opioids sib xyaw ua ke tuaj yeem ua rau muaj kev ntxhov siab, ua pa nyuaj, coma, thiab tuag.

Ntau cov tshuaj benzodiazepines tau tawg hauv daim siab thiab thaum ua ke nrog cov tshuaj uas thaiv qhov kev ua no, cov ntshav tuaj yeem nce, ua rau muaj kev phiv. Lorazepam, oxazepam thiab temazepam tsis tshua muaj kev pheej hmoo vim muaj tsawg dua daim siab enzyme kev cuam tshuam.

Txawm li cas los xij, muaj ntau lwm yam kev cuam tshuam, yog li xav tau kev tshuaj ntsuam xyuas tshuaj nrog koj tus kws muag tshuaj lossis kws kho mob. Cov neeg mob yuav tsum tsis txhob tso tseg kev siv tshuaj, suav nrog benzodiazepines, yam tsis tau hu rau lawv tus kws kho mob thawj zaug. Kev txiav tawm sai sai ntawm benzodiazepines tuaj yeem ua rau cov tsos mob tshem tawm hnyav.

Herbal thiab txiv kab ntxwv qaub sib cuam tshuam

Cov tshuaj ntsuab tshuaj ntsuab thiab txiv kab ntxwv qaub tuaj yeem muaj kev cuam tshuam loj heev nrog qee yam benzodiazepines. Piv txwv ntawm qee qhov kev sib cuam tshuam ntau dua suav nrog:

  • Kev : Kev siv ua ke ntawm kava thiab benzodiazepines tsis pom zoo. Ib tsab ntawv ceeb toom qhia tias kava tuaj yeem ua rau lub hauv paus paj hlwb muaj kev cuam tshuam ntawm benzodiazepines. Nyob rau hauv tsab ntawv ceeb toom, ib tug txiv neej 54 xyoo tau kho nrog alprazolam los ua semicomatose nrog lethargy thiab disorientation tom qab nws tus kheej noj tshuaj kava rau 3 hnub. Lub tswv yim meej ntawm kev sib cuam tshuam tsis paub, tab sis xav tias muaj kev sib ntxiv lossis kev sib koom ua ke ntawm CNS. Cov neeg mob ntawm benzodiazepines yuav tsum tau qhia kom sab laj nrog lawv tus neeg saib xyuas ua ntej siv lwm yam tshuaj.
  • St. John lub wort : Kev siv cov St. John's wort nrog benzodiazepines tuaj yeem ua rau muaj kev phiv xws li kiv taub hau, tsaug zog, kev xav tsis zoo thiab kev nyuaj siab. Koj yuav tsum zam lossis txwv kev siv cawv thaum kho nrog cov tshuaj no. Tsis txhob tsav tsheb lossis ua haujlwm cov khoom siv phom sij kom txog thaum koj paub tias cov tshuaj cuam tshuam rau koj li cas. Nws yog ib qho tseem ceeb uas yuav tau qhia koj tus kws kho mob txog txhua yam tshuaj uas koj siv, suav nrog cov vitamins thiab tshuaj ntsuab.
  • Grapefruit thiab kua txiv hmab txiv ntoo : Grapefruit thiab kua txiv hmab txiv ntoo tuaj yeem cuam tshuam nrog qee yam benzodiazepines xws li midazolam , triazolam , thiab alprazolam . Cov ntshav ntawm cov tshuaj no yuav nce ntxiv yog tias noj tom qab haus cov kua txiv hmab txiv ntoo thiab ua rau muaj kev phom sij txaus ntshai. Lub tswv yim txheej txheem yog CYP450 3A4 enzyme inhibition. Sib tham txog kev siv cov khoom txiv kab ntxwv nrog koj tus kws kho mob. Tsis txhob nce lossis txo cov khoom noj txiv kab ntxwv hauv koj cov zaub mov yam tsis tau tham nrog koj tus kws kho mob thawj zaug. Cov kua txiv kab ntxwv tsis zoo li cuam tshuam nrog benzodiazepines.

Ntau cov benzodiazepines tau tawg hauv daim siab thiab tuaj yeem cuam tshuam nrog cov tshuaj uas tseem muaj kev ua haujlwm hauv daim siab. Piv txwv li, lub 3A4 inhibitors lossis CYP2C19 inhibitors tuaj yeem ua rau muaj kev cuam tshuam nrog benzodiazepines. Qee cov benzodiazepines xws li alprazolam, chlordiazepoxide, clonazepam, thiab diazepam yog tag nrho lossis ib nrab CYP3A4 lossis CYP2C19 substrates, txhais tau tias lawv tau metabolized (tawg) mus rau qee qhov los ntawm ib lossis ob qho tib si ntawm daim siab enzymes.

  • Yog tias benzodiazepines uas yog CYP3A4 lossis CYP2C19 substrates siv nrog lwm cov tshuaj uas inhibits (blocks) cov enzymes, cov tshuaj qib ntawm benzodiazepine yuav sawv vim txo qis metabolism thiab excretion. Cov tshuaj ntau ntau txhais tau tias muaj kev pheej hmoo ntau dua rau cov kev mob tshwm sim.
  • Ob hom tshuaj no yuav tsum tau zam nrog qee yam benzodiazepines lossis benzodiazepine yuav tsum tau muab rau hauv koob me me; nrog koj tus kws kho mob lossis kws muag tshuaj.

Piv txwv ntawm cov tshuaj uas tau txiav txim siab CYP3A4 inhibitors suav nrog:

Piv txwv ntawm cov tshuaj uas tau txiav txim siab CYP2C19 inhibitors suav nrog:

Benzodiazepine Siv rau hauv cev xeeb tub thiab pub niam mis

Kev xeeb tub

Feem ntau, benzodiazepines yuav tsum tsis txhob siv thaum cev xeeb tub.

FDA tau txiav txim siab qhov kev pheej hmoo ntawm cev xeeb tub (A, B, C, D thiab X), thiab suav nrog cov ntsiab lus ntawm kev pheej hmoo, kev sib tham ntawm cov ntaub ntawv txhawb cov ntsiab lus, thiab cov ntaub ntawv tseem ceeb los pab cov kws kho mob txiav txim siab thiab tawm tswv yim. poj niam txog kev siv tshuaj thaum cev xeeb tub. Saib cov seem cev xeeb tub ntawm txhua tus neeg tshuaj monograph txhawm rau txiav txim siab xeeb tub lossis txiaj ntsig.

Benzodiazepines yav dhau los tau nyob hauv FDA Pregnancy Qeb D , txhais tau hais tias muaj pov thawj zoo ntawm tib neeg fetal txaus ntshai raws li cov ntaub ntawv tsis zoo los ntawm kev tshawb nrhiav lossis kev lag luam lossis kev tshawb fawb hauv tib neeg, tab sis cov txiaj ntsig muaj peev xwm tuaj yeem lav kev siv cov tshuaj hauv cov poj niam cev xeeb tub txawm tias muaj kev pheej hmoo. Raws li tus kws kho mob cov lus qhia, qee cov tshuaj benzodiazepines tuaj yeem muab rau hauv cov xwm txheej hnyav heev thiab ua rau muaj kev phom sij rau lub neej xws li xwm txheej epilepticus.

Kev pub niam mis

Cov poj niam uas pub niam mis yuav tsum tsis txhob siv benzodiazepines tshwj tsis yog lawv tus kws kho mob tau hais kom ua. Benzodiazepines tuaj yeem sib sau hauv cov kua mis thiab hauv cov menyuam mos noj mis. Ib txhia tshuaj benzodiazepines tej zaum yuav tsim nyog kho rau cov poj niam uas yog pub niam mis , tab sis tsuas yog nyob rau hauv kev coj ntawm tus kws kho mob.

Kawm ntxiv : Tshuaj siv thaum pub niam mis

Flumazenil siv los ua benzodiazepine tshuaj tua kab mob

Flumazenil (Romazicon - brand discontinued) yog siv los thim rov qab cov nyhuv sedative ntawm benzodiazepine thaum siv rau kev kho mob thiab kev kho mob hauv benzodiazepine overdose. Flumazenil thaiv cov nyhuv hauv nruab nrab ntawm benzodiazepines los ntawm kev sib tw sib tw ntawm benzodiazepine receptor site. Ib tug neeg mob uas muaj a benzodiazepine overdose tej zaum yuav muaj cov tsos mob thiab cov tsos mob hauv qab no:

  • kiv taub hau
  • tsis muaj peev xwm hais lus lossis teb
  • tsis meej pem
  • qaug zog
  • burred tsis pom kev los yog nystagmus
  • kev ntxhov siab
  • qaug zog
  • ntshav siab
  • ua pa nyuaj siab
  • kev xav tsis thoob
  • nrog rau

Kev siv cov flumazenil hauv benzodiazepine overdose yog qhov tsis txaus ntseeg thiab qhov kev pheej hmoo yuav ntau dua qhov txiaj ntsig tau.

  • Flumazenil tuaj yeem ua tau zoo hauv kev thim rov qab sedation uas tshwm sim hauv benzodiazepine overdose, tab sis nws cov teebmeem ntawm kev thim rov qab ntawm kev nyuaj siab ua tsis taus pa yog tsawg dua.
  • Vim nws luv luv ib nrab-lub neej, sedation thiab ua pa nyuaj siab yuav rov tshwm sim.
  • Tus neeg mob yuav tsum tau soj ntsuam los ntawm ib tus kws kho mob nrog cov cuab yeej resuscitative rau kev rov ua kom rov zoo li qub lossis ua pa nyuaj rau tsawg kawg 2 teev tom qab tswj hwm flumazenil lossis kom txog thaum tus neeg mob nyob ruaj khov.

Benzodiazepines feem ntau coingested nrog lwm yam tshuaj, xws li opioids, nyob rau hauv overdose. Tsis tas li ntawd, hauv cov neeg mob uas ua siab ntev lossis nyob ntawm qhov cuam tshuam ntawm benzodiazepines, kev siv flumazenil tuaj yeem ua rau cov tsos mob ntawm benzodiazepine tshem tawm hnyav thiab qaug dab peg; yog li ntawd, nws siv yog contraindicated hauv cov neeg mob no.

Kev rho tawm Benzodiazepine

Lub cev dependence rau benzodiazepines , tuaj yeem tshwm sim tom qab siv cov tshuaj kho mob ntev, lossis txawm tias tom qab lub sijhawm kho luv luv hauv qee cov neeg mob. Feem ntau, benzodiazepines yuav tsum tau txiav maj mam kom txo qis cov tsos mob xws li:

  • pw tsaug zog cuam tshuam thiab rebound insomnia
  • kev ntxhov siab
  • chim siab
  • siab ntxhov siab
  • qaug zog
  • qhov muag tsis pom kev
  • ceeb ntshai
  • tshee
  • tawm hws/flushing
  • xeev siab thiab ntuav
  • mob taub hau
  • qaug dab peg
  • mob hlwb
  • kev xav tsis thoob

Cov tshuaj ua kom luv luv ua rau luv luv thiab hnyav dua cov tshuaj tiv thaiv uas feem ntau pib hauv 24 teev tom qab txiav tawm. Ntev-ua yeeb yam benzodiazepines muaj kev txhim kho qeeb ntawm cov tsos mob tshem tawm uas feem ntau pib ob peb hnub tom qab txiav tawm, tab sis ncov txog li 7 hnub.

Lub sijhawm ntev uas yuav tsum tau ua kom tiav qhov kev tshem tawm benzodiazepine nyob ntawm tus neeg mob tus yam ntxwv, hom benzodiazepine, muaj peev xwm los daws kev ntxhov siab cuam tshuam nrog kev tshem tawm, thiab thawj qhov laj thawj rau kev siv benzodiazepine. Lub sij hawm xav tau los txo qis ntawm benzodiazepine feem ntau yog li ntawm 4 lub lis piam mus rau 6 lub hlis, tab sis tuaj yeem dhau ib xyoos hauv qee qhov xwm txheej.

Kev tshem tawm sai tuaj yeem ua rau muaj tus mob ntawm cov tsos mob hnyav hauv ntau tus neeg mob. Txhua lub sijhawm, benzodiazepines yuav tsum tau txiav tawm raws li kev saib xyuas ntawm tus kws kho mob.

Cov nqi ntawm benzodiazepines

Feem ntau benzodiazepines yog muaj nyob rau hauv daim ntawv generic uas tuaj yeem ua rau kev txuag nyiaj rau cov neeg mob. Feem ntau, benzodiazepines yog siv rau kev kho mob luv luv, uas tseem yuav txo cov nuj nqis.

Yog tias tus nqi muaj kev txhawj xeeb rau cov tshuaj, nco ntsoov nrog koj tus kws kho mob tham ua ntej Cov tshuaj tau sau thiab sib tham txog kev xaiv nrog koj tus kws muag tshuaj, thiab. Koj tuaj yeem txuag tau nyiaj ntawm qee yam tshuaj los ntawm faib koj cov ntsiav tshuaj hauv ib nrab. Nrog koj tus kws muag tshuaj xyuas kom paub tseeb tias qhov no ua tau.

Online daim coupon thiab chaw tsim tshuaj paus pab neeg mob yog lwm yam kev xaiv. Nco ntsoov tias cov nqi tshuaj yuav hloov tau txhua lub sijhawm thiab yuav txawv ntawm cov khw muag tshuaj. Nco ntsoov xyuas nrog koj lub tsev muag tshuaj hauv zos kom paub tus nqi tseeb.

Benzodiazepines siv sab nraum Teb Chaws Asmeskas

Lwm cov benzodiazepines thoob ntiaj teb muaj nyob rau hauv uas tsis pom zoo siv rau hauv Teb Chaws Asmeskas Txhua lub generic tej zaum yuav muaj ntau lub npe lag luam cuam tshuam nrog cov khoom, thiab cov npe hom yuav txawv ntawm lub teb chaws. Cov tshuaj benzodiazepines thoob ntiaj teb muaj kev siv zoo ib yam li cov kev pom zoo hauv Teb Chaws Asmeskas, xws li kev ntxhov siab, pw tsaug zog lossis sedation, siv rau kev phais premedication, rau qaug dab peg, thiab kev tawm tsam. International benzodiazepines muaj xws li:

  • bromazepam
  • flunitrazepam
  • nitrazepam
  • npe azep
  • lormetazepam
  • loprazolam

Rohypnol (flunitrazepam) yog ib qho nruab nrab-ua yeeb yam benzodiazepine nrog cov khoom dav dav zoo ib yam li Valium (diazepam). Nws tsis muaj nyob rau hauv Teb Chaws Asmeskas, txawm hais tias nws tuaj yeem pom raug cai hauv lwm lub tebchaws uas nws siv rau kev kho mob insomnia thiab ua tshuaj loog ua ntej. Rohypnol yog siv tsis raug cai los txo cov kev nyuaj siab los ntawm kev tsim txom ntawm stimulants, xws li yeeb tshuaj yeeb thiab tshuaj yeeb, thiab nyob rau hauv cov ntaub ntawv ntawm kev sib deev yuam kev uas yog induces nco tsis tau nyob rau hauv tus neeg raug tsim txom. Nws feem ntau hu ua 'hnub rape' tshuaj.

Benzodiazepines thiab kev dag ntxias online

Cov khw muag tshuaj hauv Internet muaj kev phom sij ntau ntxiv rau cov neeg mob thiab lawv txoj kev noj qab haus huv. Cov tshuaj cuav thiab cov tshuaj cuav feem ntau tau ua lag luam thiab muag hauv online rau cov neeg siv khoom tsis txaus siab. Ceev faj ntawm kev yuav khw muag tshuaj hauv online; Feem ntau, cov neeg tau txais kev pab hauv Teb Chaws Asmeskas yuav tsum tsuas yog yuav cov tshuaj los ntawm lawv lub tsev muag tshuaj hauv zos lossis cov phiaj xwm kev noj qab haus huv uas tswj hwm lub tsev muag tshuaj xa ntawv.

Txhawm rau pab txheeb xyuas cov tshuaj tsis paub lossis tshuaj ntsiav, siv lub Pill Identification Wizard . Yog tias koj tsis tuaj yeem txheeb xyuas koj cov tshuaj, nws yuav raug dag; tiv tauj koj tus kws kho mob kom paub ntxiv.

Qhov chaw

  • National Institute on Drug Abuse. Benzodiazepines thiab Opioids. Tau txais los ntawm Lub Ob Hlis 26, 2020 thaum https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids .
  • Frank L, Wolfson A, Grayzel J. Cov txheej txheem sedation hauv cov neeg laus sab nraum chav ua haujlwm. Txog hnub tim. Tau txais los ntawm Lub Ib Hlis 19, 2019 ntawm https://www.uptodate.com/contents/procedural-sedation-in-adults-outside-the-operating-room
  • Craske M, Bystritsky A, Stein M, Hermann R. Txoj hauv kev los kho cov kev ntxhov siab hauv cov neeg laus. Txog hnub tim. Tau txais los ntawm Lub Ib Hlis 19, 2019 ntawm https://www.uptodate.com/contents/approach-to-treating-generalized-anxiety-disorder-in-adults
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  • American Geriatrics Society. Hloov Kho Beers Cov Cai rau Kev Siv Tshuaj Tsis Tsim Nyog Hauv Cov Neeg Laus. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. J Am Geriatr Soc. 2015. Nkag mus rau lub Kaum Ob Hlis 26, 2020. https://www.sigot.org/allegato_docs/1057_Beers-Criteria.pdf
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Cov ntaub ntawv ntxiv

Nco ntsoov sab laj nrog koj tus kws kho mob kom paub meej tias cov ntaub ntawv uas tshwm sim hauv nplooj ntawv no siv tau rau koj tus kheej.