Drug question - lopressor

[cbrons]

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risks dont ALWAYS outweigh benefits, nor is the opposite true of course , but you should know as a med student by now that clinical pictures frequently dont fit squarely within the proven evidence, guidelines, textbooks, etc, and that in some patients, higher risks are justified. What if a person has failed therapy repeatedly, is at risk for serious self harm, will not tolerate inpatient, or has no insurance for psychotherapy , but is at substantial risk if untreated, in such a case , wouldnt you think bzd's would represent a less risky option than no treatment or subpar (ie ssris) treatment? The fact that this is actually a question means that bzd for panic disorder can hardly be called "highly unethical", in such a blanket way. We were taught that bzds while not 'recommended' for long term , are frequently used because they are the least 'bad' of the available options, for the patient's health, particularly when nothing else can be implemented in a practical way.

First thing you learn about drugs is that they all represent some mix between toxicity and efficacy, and that the clinical picture must be considered in each patient in order to weigh risks vs benefits.

The ethics of using any chemical substance in any patient to achieve some physiological changes always depend on the acceptable levels of risk of harm in the patients and provider's eyes compared to the expected/desired level of benefits.

Now if prescribers were treating with chronic bzd's by default, and not disclosing some of the well known risks to their patients, I would call THAT "highly unethical"

The prognosis for individuals with primary panic disorder is very good. The vast majority of patients with respond the appropriate psychological treatment.

The problem with regular daily use of benzodiazepines is that they need constant titration. More and more research is emerging on the harmful effects of long-term benzo usage as well as the little known but very real problem of withdrawal.

Physicians who prescribe high doses of short-acting benzodiazepines for daily use in the primary care setting to patients with panic attacks are doing a great harm to their patients.

 

[kvl1027]

The prognosis for individuals with primary panic disorder is very good. The vast majority of patients with respond the appropriate psychological treatment.

The problem with regular daily use of benzodiazepines is that they need constant titration. More and more research is emerging on the harmful effects of long-term benzo usage as well as the little known but very real problem of withdrawal.

Physicians who prescribe high doses of short-acting benzodiazepines for daily use in the primary care setting to patients with panic attacks are doing a great harm to their patients.

I agree with this for the most part. There are way too many people on benzo's, it seems to be the answer, or at least an answer, for anyone who is dealing with mental health issues.

 

[Carboxide]

No my assessment is exactly correct.

Patients with PDA (Panic Disorder with Agoraphobia) can be started on a short course of benzodiazepines but this is not a long-term solution for several reasons which I suspect a pharmacy student would understand. In this case, the tranquilizers are used as a way to give the patient enough confidence to undergo cognitive behavioral therapy wherein they are exposed to the things and/or situations that trigger their panic attacks. Through repeated exposure, their level of fear decreases and they stop having panic attacks altogether. There is no long-term medication treatment for someone with primary panic disorder, and in fact long-term treatment (i.e. daily) with benzodiazepines for people with simple anxiety is highly unethical (for reasons which a pharmacy student would or should understand).

Right. But there is a HUGE, HUGE difference between panic disorder and panic disorder WITH AGORAPHOBIA. I don't see anything about this patient indicating the latter.

Also, long-term tx with BZDs isn't advisable for a lot of reasons, but ethically, it is sometimes MORE ethical than allowing a patient to suffer.