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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