Hypnotics and anxiolytics

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Benzodiazepines Benzodiazepines taken alone cause drowsiness, ataxia, dysarthria, nystagmus, and occasionally respiratory depression, and coma. Activated charcoal can be given within 1 hour of ingesting a significant quantity of benzodiazepine, provided the patient is awake and the airway is protected. Benzodiaz-epines potentiate the effects of other central nervous system depressants taken concomitantly. Use of the benzodiazepine antagonist flumazenil [unlicensed indication] can be hazardous, particularly in mixed overdoses involving tricyclic antidepressants or in benzodia-zepine-dependent patients. Flumazenil may prevent the need for ventilation, particularly in patients with severe respiratory disorders; it should be used on expert advice only and not as a diagnostic test in patients with a reduced level of consciousness.

to another; propranolol overdosage in particular may cause coma and convulsions.

Acute massive overdosage must be managed in hospital and expert advice should be obtained. Maintenance of a clear airway and adequate ventilation is mandatory. An intravenous injection of atropine is required to treat bradycardia (3mg for an adult, 40 micrograms/kg (max. 3 mg) for a child). Cardiogenic shock unresponsive to atropine is probably best treated with an intravenous injection of glucagon 2-10 mg (CHILD 50-150micrograms/kg, max. 10mg) [unlicensed indication and dose] in glucose 5% (with precautions to protect the airway in case of vomiting) followed by an intravenous infusion of 50 micrograms/kg/hour. If glucagon is not available, intravenous isoprenaline (available from 'special-order' manufacturers or specialist importing companies, see p. 988) is an alternative. A cardiac pacemaker can be used to increase the heart rate.

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Free Yourself from Panic Attacks

Free Yourself from Panic Attacks

With all the stresses and strains of modern living, panic attacks are become a common problem for many people. Panic attacks occur when the pressure we are living under starts to creep up and overwhelm us. Often it's a result of running on the treadmill of life and forgetting to watch the signs and symptoms of the effects of excessive stress on our bodies. Thankfully panic attacks are very treatable. Often it is just a matter of learning to recognize the symptoms and learn simple but effective techniques that help you release yourself from the crippling effects a panic attack can bring.

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