OPIOID AND BENZODIAZEPINE TOLERANCE AND DEPENDENCE - APPLICATION OF THEORY TO CRITICAL CARE PRACTICE

Critical care clinicians frequently manage patient pain and agitation and promote ventilator stability through use of opioids and benzodiaze pines. Often, doses of these drugs must be increased considerably over time as they lose their effectiveness-an indication of drug tolerance . Furthermore, patients can experience negative physiologic responses to withdrawal of these drugs-an indication of drug dependence. Withdra wal symptoms due to abrupt discontinuation of drug therapy can be prof ound and dangerous. It is important that clinicians understand the mec hanisms of drug therapies and their potential negative sequelae. The p urpose of this article is to present physiologic theories of opioid an d benzodiazepine actions, as well as drug tolerance and dependence, as a basis of knowledge for clinical practice. A clinical scenario of an intensive care unit patient is presented, and a care plan is offered, to provide guidance to practitioners who care for patients experienci ng the consequences of long-term opioid and benzodiazepine use.