Psych Vivas · Psychopharmacology — benzodiazepine prescribing and tapering
Benzodiazepine prescribing and tapering — consultant viva
Fellowship viva covering initiation rules, half-life/LOT, equipotency, taper craft, deprescribing evidence, opioid synergy, and emergency pitfalls.
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Study tools
Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
Examiner cards: alprazolam 2 mg TDS script; LOT list blank; equipotency table; opioid co-prescription stem; elderly falls on temazepam; EMPOWER one-liner; flumazenil in chronic user OD; 10–25% taper scaffold; withdrawal seizure after 50% cut.
Opening (definition and initiation)
AnswerShowHide
Benzodiazepines are GABA-A positive allosteric modulators. Initiation requires named indication, lowest effective oral dose, shortest duration, documented review/stop date, substance and opioid/alcohol history, falls and driving counselling, and a parallel non-GABAergic plan for chronic anxiety or insomnia.[1][2][9]
References10ShowHide
- [1]Soyka M Treatment of Benzodiazepine Dependence N Engl J Med, 2017.PMID 28614686
- [2]Brett J, Murnion B Management of benzodiazepine misuse and dependence Aust Prescr, 2015.PMID 26648651
- [3]Ashton H The diagnosis and management of benzodiazepine dependence Curr Opin Psychiatry, 2005.PMID 16639148
- [4]Sun EC, Dixit A, Humphreys K, et al. Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis BMJ, 2017.PMID 28292769
- [5]Tannenbaum C, Martin P, Tamblyn R, et al. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial JAMA Intern Med, 2014.PMID 24733354
- [6]Pottie K, Thompson W, Davies S, et al. Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline Can Fam Physician, 2018.PMID 29760253
- [7]By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults J Am Geriatr Soc, 2023.PMID 37139824
- [8]Glass J, Lanctôt KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits BMJ, 2005.PMID 16284208
- [9]Brunner E, Chen CA, Klein T, et al. Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits J Gen Intern Med, 2025.PMID 40526204
- [10]Voshaar RC, Couvée JE, van Balkom AJ, et al. Strategies for discontinuing long-term benzodiazepine use: meta-analysis Br J Psychiatry, 2006.PMID 16946355