Understanding Balance Issues Associated with Long-Term Diazepam Use- A Case Study Analysis

Question One

The patient’s difficulty in maintaining balance can be explained by the cumulative effects of diazepam. Diazepam’s mechanism of action involves promoting the inhibitory effects of gamma-aminobutyric acid (GABA) in the CNS. Some of the side effects of diazepam include drowsiness, sedation, and impaired coordination. Long-term diazepam use, 15 years for this patient, leads to accumulation of the drug and increases adverse effects, including impaired coordination and balance (Dhaliwal et al., 2023).

Question Two

The first-pass effect is a pharmacological process where a medication endures metabolism at a particular location in the body. During the first-pass effect, the concentration of the active drug is decreased before reaching the target site of action or systemic circulation. First-pass metabolism can be circumvented by using alternative routes in drug administration, like intravenous administration. Administering the drug directly into the systemic circulation helps bypass the first-pass effect of organ-avoiding metabolism (Herman & Santos, 2023).

Question Three

The signs of confusion in the patient are most likely caused by the anticholinergic effects of diphenhydramine. Being a first-generation antihistamine, diphenhydramine crosses the blood-brain barrier into the central nervous system, where it causes effects such as confusion, particularly in older adults who are at risk of anticholinergic side effects (Sicari & Zabbo, 2023).