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    《ISPN学习》总第608期
    日期:2020-03-20 16:40:00    
     
    《ISPN学习》2020年03月20日总第608期
      
     Saunders 8th 中英对照 
    QQ:1499404819


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    ISPN  Review  
     
    Benzodiazepines Used as Anxiolytics
    抗焦虑药苯二氮卓类

    Benzodiazepines, the most frequently used anxiolytic drugs, prevent anxiety without causing much associated sedation. In addition, they are less likely to cause physical dependence than many of the older sedatives/hypnotics that are used to relieve anxiety. The benzodiazepines used as anxiolytics include alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), estazolam (ProSom), flurazepam (Dalmane), lorazepam (Ativan), oxazepam (Serax), quazepam (Doral), temazepam (Restoril), and triazolam (Halcion).
    苯二氮卓类是最常用的抗焦虑药,用于预防焦虑,不会引起太多的相关镇静。此外,比起其他老一点的用于减轻焦虑的镇静/催眠药,苯二氮卓类药引起躯体依赖的可能性更小。用于抗焦虑的苯二氮卓类药包括阿普唑仑 (安宁神)、氯氮卓(利眠灵)、氯拉卓酸 (氯卓酸钾)、地西泮(待捷盼)、艾司唑仑 (悠乐丁)、氟西泮 (氟安定)、劳拉西泮 (氯羟安定)、奥沙西泮 (舒宁)、夸西泮 (多拉尔)、替马西泮 (羟基安定)和三唑仑(海乐神)。

    Therapeutic Actions and Indications 治疗作用和适应症

    The benzodiazepines are indicated for the treatment of the following conditions: anxiety disorders, alcohol withdrawal, hyperexcitability and agitation, and preoperative relief of anxiety and tension to aid in balanced anesthesia. These drugs act in the limbic system and the RAS to make gammaaminobutyric acid (GABA) more effective, causing interference with neuron firing. GABA stabilizes the postsynaptic cell. This leads to an anxiolytic effect at doses lower than those required to induce sedation and hypnosis. The exact mechanism of action is not clearly understood.
    苯二氮卓类药适用于治疗下列病症:焦虑症、酒精戒断症、过度兴奋、激动及用于术前缓解焦虑和情绪紧张以帮助平衡麻醉。这些药物作用于边缘系统和RAS,增强伽玛氨酪酸(GABA)效果,干扰神经元激发。GABA稳定突触后细胞,从而在诱导镇静和催眠时,所用剂量比原先需要的小,但依然可以产生相应的抗焦虑效应。确切的作用机制尚不清楚。

    Pharmacokinetics 药代动力学

    The benzodiazepines are well absorbed from the gastrointestinal (GI) tract, with peak levels achieved in 30 minutes to 2 hours. They are lipid soluble and well distributed throughout the body, crossing the placenta and entering breast milk. The benzodiazepines are metabolized extensively in the liver. Patients with liver disease must receive a smaller dose and be monitored closely. Excretion is primarily through the urine.
    苯二氮卓类胃肠道吸收良好,30分钟到2小时达峰;脂溶性;身体分布充分,可穿透胎盘并进入母乳。苯二氮卓类主要经肝代谢。因此,肝病患者应减少剂量并密切监测。经尿排出为主。

    Contraindications and Cautions 禁忌和注意事项

    Contraindications to benzodiazepines include allergy to any benzodiazepine; psychosis, which could be exacerbated by sedation; and acute narrow-angle glaucoma, shock, coma, or acute alcoholic intoxication, all of which could be exacerbated by the depressant effects of these drugs.
    苯二氮卓类药禁忌症包括对苯二氮卓类药的任何过敏;精神病,此病可因镇静加重;及急性狭角青光眼、休克、昏迷或急性酒精中毒等,这些药物的抑制效应可加强这些病情。
    In addition, these sedative/hypnotics are contraindicated in pregnancy because a predictable syndrome of cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, or pyloric stenosis occurs when they are taken in the first trimester. Neonatal withdrawal syndrome may also result.
    此外,妊娠时也禁忌使用这些镇静/催眠药,因为妊娠初期服用这些药物会出现可预测的唇裂或腭裂综合症、腹股沟疝、心脏缺陷、小头畸形、幽门狭窄等。也可能导致新生儿戒断综合征。
    Breast-feeding is also a contraindication because of potential adverse effects on the neonate (e.g., sedation). Use with caution in elderly or debilitated patients because of the possibility of unpredictable reactions and in cases of renal or hepatic dysfunction, which may alter the metabolism and excretion of these drugs, resulting in direct toxicity. Dose adjustments usually are needed for such patients. Box 20.3 provides information about the effect of benzodiazepines in African American patients.
    鉴于对新生儿的潜在不良效应(如镇静),哺乳期也禁忌使用。
    对于老年或虚弱患者,由于出现不可预测的反应的可能性,用药也应慎重;有肝或肾功能障碍的患者,因为其药物代谢和排泄功能改变,容易导致直接的毒性反应,也应慎重。这些患者通常需要调整剂量。表框20.3列出了苯二氮卓类药对非洲裔美国人患者的效应信息。

    Adverse Effects 不良效应

    The adverse effects of benzodiazepines are associated with the impact of these drugs on the central and peripheral nervous systems. Nervous system effects include sedation, drowsiness, depression, lethargy, blurred vision, headaches, apathy, light-headedness, and confusion. In addition, mild paradoxical excitatory reactions may occur during the first 2 weeks of therapy.
    苯二氮卓类药的不良效应与这些药物对中枢和外周神经系统的影响有关。神经系统效应包括镇静、瞌睡、抑制、倦怠、视力模糊、头痛、情感淡漠、轻度头痛和意识模糊。此外,在治疗前两周还会出现轻度的矛盾性兴奋反应
    Several other kinds of adverse effects may occur. GI conditions such as dry mouth, constipation, nausea, vomiting, and elevated liver enzymes may result. Cardiovascular problems may include hypotension, hypertension, arrhythmias, palpitations, and respiratory difficulties. Hematological conditions such as blood dyscrasias and anemia are possible.
    还会出现其他几种不良效应。GI状况,如口干、便秘、恶心、呕吐和肝酶升高;心血管问题,如低血压、高血压、心律障碍、心悸、呼吸困难;血液学状况,如恶血质、贫血等也有可能出现。
     
    Vocabulary for Today   
     
    alprazolam – n. 阿普唑仑
    Xanax – n. 安宁神
    chlordiazepoxide – n. 氯氮卓
    Librium – n. 利眠灵
    clorazepate – n. 氯拉卓酸
    Tranxene – n. 氯卓酸钾
    diazepam – n. 地西泮
    Valium – n. 待捷盼
    estazolam – n. 艾司唑仑
    ProSom – n. 悠乐丁
    flurazepam -- 氟西泮
    Dalmane – n. 氟安定
    lorazepam – n. 劳拉西泮
    Ativan – n. 氯羟安定
    oxazepam  -- n. 奥沙西泮
    Serax – n. 舒宁
    quazepam – n. 夸西泮
    Doral – n. 多拉尔
    temazepam – n. 替马西泮
    Restoril – n. 羟基安定
    triazolam – n. 三唑仑
    Halcion – n. 海乐神
    GABA -- gammaaminobutyric acid伽玛氨酪酸
    postsynaptic cell –突触后细胞

     
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    Video  
     
    Sedative and Hypnotic Drugs – Overview
     
     
      Test  
     
     1. For which of the following medical conditions would the nurse anticipate that an antianxiety agent would not be indicated?
    A. Seizure disorders
    B. Alcohol detoxification
    C. Parkinson’s disease
    D. Panic disorder
    2. Diazepam (Valium) is prescribed to a client with alcohol withdrawal. Which of the following statements made by the client indicates an understanding of the treatment regimen?
    A. “This medication causes a blurring of vision”.
    B. “This medication will cause a decrease platelet and white blood cell count in my blood”.
    C. “I’ll have my physician to lower my dosage once I started to feel okay”.
    D. “Drinking grapefruit can decrease the side effects with this medication”.
      
    奥医教育ISPN / NCLEX-RN“在线自测”题库正式,复习练习、效果检验一站完成。
     
     
    答案
    Key to Questions
    1. C. Parkinson’s disease. 
    Benzodiazepines may exacerbate the symptoms of Parkinson’s disease.
    2. D. “Drinking grapefruit can decrease the side effects with this medication”.
    Diazepam (Valium) can cause side effects such as sleepiness and drowsiness. Meanwhile, grapefruit can reduce the metabolism of this drug. This can result in increased pharmacologic effect of Valium as well as its side effects.
     





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