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Now advantages of Librium. First of all, which has the longer half life? Ativan or Librium? Which lasts longer? Librium does. Why is that an advantage? Well, let’s say you are at some small hospital, small rural hospital, where the nursing staff is not really what it should be and somebody misses a dose of the medication. You are covered if you’ve got Librium and you are not covered if you have Ativan. Let’s talk about the more likely, patient signing out AMA. Do alcoholics like to sign out of the hospital AMA? Yes they do. Why do they do that? So they can go and drink. So it’s not uncommon for them to say, heck with this doc. I’m out of here. Give me the AMA forms. You start talking to them and they are just, “Gimme the forms, gimme the forms.” And where’s the first place they go? The bar or the liquor store to appropriate some medication for their withdrawal feelings. By the time they get from the hospital door to the bar they are covered if they are on Librium. They are not going to start to show withdrawal, which they may show if they are on a shorter acting benzodiazepine like lorazepam. So that’s an advantage of chlordiazepoxide or Librium. Generic medications online at Licensed Generic pharmacy.
Librium is more accepted. Also Tegretol. You can load somebody with Tegretol, give them like 400 bid. Tegretol is carbamazepine, not really a GABA receptor thing. Of course, we know why the benzodiazepines are thought to work for alcohol. There’s cross-tolerance with GABA. You know, Tegretol really doesn’t have that but for some reason it seems to help prevent even alcohol withdrawal seizures and symptoms in addition to just the seizures. Common dose: Librium 50 mg qid. then taper after 48 hours.
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Severe anxiety. Because we want to distinguish between panic attacks and generalized anxiety disorder, which we will talk about later in the day. Is it new? Again, it kind of goes along with the confusion. If this is new then it’s more of an emergency type of thing. If it’s not new, then we are not as worried about it from an emergency perspective. Although you still may have to deal with it as a physician. Has it been worked up and/or treated? What’s your medical history? Any psychiatric or substance abuse? Important question: how much caffeine do you use? There are people out there who will have panic attacks if they have three cups of coffee per day. But ask about caffeine. Any over-the-counter drugs? Things like Mini-Thins, that’s like pseudoephedrine and those kinds of things they have back in Michigan. Sometimes kids and people older than kids – young adults and middle-aged people – will abuse these over-the-counter ephedrine type things or over-the-counter caffeine pills. When was the last time you ate? There’s two reasons to ask that. One is, what are we thinking about if they haven’t eaten all day and now they are anxious and dizzy? Hypoglycemia. Another important reason we ask that is, it could impair the absorption of the benzodiazepine. If they’ve got a full stomach and we give them two Xanax in the ER it might take a little while longer for their anxiety to calm down. So that’s two key questions. It’s not that they need Xanax. What they need is a peanut butter sandwich.
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