Post by Neo on Jan 19, 2005 21:23:28 GMT -5
Attributed to Norbert
Ativan is an anxiety medication. It is a benzodiazapine.
Most Anxiolytics are in a chemical class of drugs called benzodiazepine. Specific benzodiazepines are approved for various uses as sleep inducing or anti-anxiety purposes. Cautions for benzodiazepines used for anxiety are similar to those for sleeping pills: they lose their effect over time, they become habit forming when used long term (over four weeks),and they are sedating and therefore pose a risk of falls. They can contribute to cognitive impairment (confusion). They also increase depressive tendencies so they should not be used for people with depression or psychotic tendencies.
The confusion is caused by the fact that benzodiazapines are anticholinergic. They decrease the cholinesterase neurotransmitters that are already reduced in Alzheimers, and that doctors use the mildly effective aricept to increase.
I have heard dementia specialists and read medical articles that state that benzodiazapines are inappropriate for dementia patients.
Also Anticholinergic agents are inappropriate for any elderly person.
And benzodiazapines are not to be used for more than 2 or 3 weeks for ANY person.
When is it appropriate to use ativan?, when a patient is standing in the middle of a hospital hallway shouting and screaming (out of control). Then ativan is often used to calm them down.
My LO was on low doses of two anticholinergic meds, Ativan (0.5 mg) and Risperdal (0.5 mg x2/day). Over several months, she developed severe anxiety and then Paranoia, constantly fearing that "they" were going to kill her. She also developed a stooped posture and extreme slowing of movement. She looked like she was in slow motion when sitting or standing. This is a parkinsonian like movement symptom.
This drug regimen was initiated in the psych ward of a major hospital during a "medication adjustment". When a dementia specialist discontinued these two meds, the paranoia, anxiety and parkinsonian movements went away almost immediately. So the Acetycholine reduction caused confusion, the emergence of psychosis and a movement disorder, all classic, just as the medical literature predicts.
Is ativan causing your grandmother any harm? Probably not any harm that is lasting. It is simply reducing an important neurothansmitter while she is taking it.
Because it is addictive, do not suddenly stop using it without consulting a physician.
The following information comes from a lecture by neurologist Dr Richard Powers.
“Ativan is a benzodiazepine. Benzodiazepines work on a chemical transmitter in the brain called GABA. GABA is the same chemical transmitter that is affected by alcohol. That is why when somebody has alcohol withdrawal, we treat them with a benzodiazepine; because it basically replaces on the GABA receptor the alcohol with a benzodiazepine. The reason, (I don’t want to make this into a psycho-pharmacology lecture), but the reason I mention that is, because these drugs, the benzodiazepines, (Ativan, Xanax, Valium, Librium) all work the same way that alcohol does, they have pretty much the same side effects. They cause you to be drowsey, unsteady, and can make you more confused. Or, alternatively – You know there’s two kind of drunks. There’s the mellow, sleepy drunk. And then there’s the rowdy, want to fight with you drunk. Some patients it actually makes them disinhibited; they can actually become more agitated. Of all the medicines you listed off to me, if I had to pick one that I’d want to avoid, it would be the Ativan.”
Question – What would you use to calm her down (wanting to leave dementia unit)
Answer (summarized) - If she thinks she is being imprisoned, and this is a conspiracy – this is a delusion and I would increase the antipsychotic. However if she is attempting to leave because she is bored, then the facility needs to work on their programming. And improve the environment if there are confusing/disturbing aspects in the environment.
The discussion continues - regarding activities in a facility.
The full lecture is available at-
www.askdrjamie.net/selfcareradio.html
Understanding the Symptoms of Dementia by Understanding How the Brain Works
quotes from the web
-------------------------
www.emedicinehealth.com/articles/39041-6.asp
(regarding huntington disease dementia)
Benzodiazepines
These drugs are most often used to rapidly calm a person who is extremely agitated and/or anxious. These drugs are not widely used in people with dementia because they can actually increase memory problems and confusion. An example is lorazepam (Ativan).
--------------------------------
www.alzheimers.org.uk/Caring_for_someone_with_dementia/Unusual_behaviour/advice_drugsbehaviour.htm
British Alzheimers society
Dementia: drugs used to relieve behavioural symptoms
Side-effects
• There are many different benzodiazepines, some with a short duration of action, such as lorazepam and oxazepam, and some with longer action, such as chlordiazepoxide and diazepam. All of these drugs may cause excessive sedation, unsteadiness and a tendency to fall, and they may accentuate any confusion and memory deficits that are already present.
------------------------------
www.postgradmed.com/issues/2004/06_04/smith.htm
Postgraduate medicine online
Behavioral problems in dementia
Physicians should take care not to prescribe medications that may be inappropriate for the elderly. For instance, benzodiazepines, while sometimes useful for acute anxiety or agitation, can lead to increased confusion, falls, and hip fractures in a population already at risk.
-------------------------
www.patientcareonline.com/patcare/article/articleDetail.jsp?id=112536
Patient Care
Topics in Geriatrics: Confronting dementia
Benzodiazepines are not recommended for first-line use in the agitated patient because paradoxical agitation occurs in about 10% of those treated. Benzodiazepines with a short half-life should be used infrequently and in low dosages. Regular use of benzodiazepines can lead to tolerance, addiction, depression, and cognitive impairment.
Ativan is an anxiety medication. It is a benzodiazapine.
Most Anxiolytics are in a chemical class of drugs called benzodiazepine. Specific benzodiazepines are approved for various uses as sleep inducing or anti-anxiety purposes. Cautions for benzodiazepines used for anxiety are similar to those for sleeping pills: they lose their effect over time, they become habit forming when used long term (over four weeks),and they are sedating and therefore pose a risk of falls. They can contribute to cognitive impairment (confusion). They also increase depressive tendencies so they should not be used for people with depression or psychotic tendencies.
The confusion is caused by the fact that benzodiazapines are anticholinergic. They decrease the cholinesterase neurotransmitters that are already reduced in Alzheimers, and that doctors use the mildly effective aricept to increase.
I have heard dementia specialists and read medical articles that state that benzodiazapines are inappropriate for dementia patients.
Also Anticholinergic agents are inappropriate for any elderly person.
And benzodiazapines are not to be used for more than 2 or 3 weeks for ANY person.
When is it appropriate to use ativan?, when a patient is standing in the middle of a hospital hallway shouting and screaming (out of control). Then ativan is often used to calm them down.
My LO was on low doses of two anticholinergic meds, Ativan (0.5 mg) and Risperdal (0.5 mg x2/day). Over several months, she developed severe anxiety and then Paranoia, constantly fearing that "they" were going to kill her. She also developed a stooped posture and extreme slowing of movement. She looked like she was in slow motion when sitting or standing. This is a parkinsonian like movement symptom.
This drug regimen was initiated in the psych ward of a major hospital during a "medication adjustment". When a dementia specialist discontinued these two meds, the paranoia, anxiety and parkinsonian movements went away almost immediately. So the Acetycholine reduction caused confusion, the emergence of psychosis and a movement disorder, all classic, just as the medical literature predicts.
Is ativan causing your grandmother any harm? Probably not any harm that is lasting. It is simply reducing an important neurothansmitter while she is taking it.
Because it is addictive, do not suddenly stop using it without consulting a physician.
The following information comes from a lecture by neurologist Dr Richard Powers.
“Ativan is a benzodiazepine. Benzodiazepines work on a chemical transmitter in the brain called GABA. GABA is the same chemical transmitter that is affected by alcohol. That is why when somebody has alcohol withdrawal, we treat them with a benzodiazepine; because it basically replaces on the GABA receptor the alcohol with a benzodiazepine. The reason, (I don’t want to make this into a psycho-pharmacology lecture), but the reason I mention that is, because these drugs, the benzodiazepines, (Ativan, Xanax, Valium, Librium) all work the same way that alcohol does, they have pretty much the same side effects. They cause you to be drowsey, unsteady, and can make you more confused. Or, alternatively – You know there’s two kind of drunks. There’s the mellow, sleepy drunk. And then there’s the rowdy, want to fight with you drunk. Some patients it actually makes them disinhibited; they can actually become more agitated. Of all the medicines you listed off to me, if I had to pick one that I’d want to avoid, it would be the Ativan.”
Question – What would you use to calm her down (wanting to leave dementia unit)
Answer (summarized) - If she thinks she is being imprisoned, and this is a conspiracy – this is a delusion and I would increase the antipsychotic. However if she is attempting to leave because she is bored, then the facility needs to work on their programming. And improve the environment if there are confusing/disturbing aspects in the environment.
The discussion continues - regarding activities in a facility.
The full lecture is available at-
www.askdrjamie.net/selfcareradio.html
Understanding the Symptoms of Dementia by Understanding How the Brain Works
quotes from the web
-------------------------
www.emedicinehealth.com/articles/39041-6.asp
(regarding huntington disease dementia)
Benzodiazepines
These drugs are most often used to rapidly calm a person who is extremely agitated and/or anxious. These drugs are not widely used in people with dementia because they can actually increase memory problems and confusion. An example is lorazepam (Ativan).
--------------------------------
www.alzheimers.org.uk/Caring_for_someone_with_dementia/Unusual_behaviour/advice_drugsbehaviour.htm
British Alzheimers society
Dementia: drugs used to relieve behavioural symptoms
Side-effects
• There are many different benzodiazepines, some with a short duration of action, such as lorazepam and oxazepam, and some with longer action, such as chlordiazepoxide and diazepam. All of these drugs may cause excessive sedation, unsteadiness and a tendency to fall, and they may accentuate any confusion and memory deficits that are already present.
------------------------------
www.postgradmed.com/issues/2004/06_04/smith.htm
Postgraduate medicine online
Behavioral problems in dementia
Physicians should take care not to prescribe medications that may be inappropriate for the elderly. For instance, benzodiazepines, while sometimes useful for acute anxiety or agitation, can lead to increased confusion, falls, and hip fractures in a population already at risk.
-------------------------
www.patientcareonline.com/patcare/article/articleDetail.jsp?id=112536
Patient Care
Topics in Geriatrics: Confronting dementia
Benzodiazepines are not recommended for first-line use in the agitated patient because paradoxical agitation occurs in about 10% of those treated. Benzodiazepines with a short half-life should be used infrequently and in low dosages. Regular use of benzodiazepines can lead to tolerance, addiction, depression, and cognitive impairment.