A 70-year-old woman is in your office complaining of recently having trouble maintaining her balance after taking diazepam (valium). She occasionally takes diazepam when she feels anxious and has trouble sleeping. She has a 15-year history of taking diazepam. Q1. Explain the cause of this patient’s difficulty in maintaining her balance? Q2. Diazepam experiences a significant first-pass effect. What is the first-pass effect, and how can first-pass metabolism be circumvented?

Question 1

The patient’s difficulty maintaining her balance is due to the side effects of diazepam. Diazepam is a central nervous system depressant that can lead to dizziness, drowsiness, and impaired coordination (Ho et al., 2023). With a 15-year history of taking diazepam, her body may have developed tolerance, requiring higher doses, which can exacerbate these side effects. Additionally, she may be more susceptible to the drug’s sedative effects due to her age (Ho et al., 2023). It is essential to evaluate her medication regimen and consider alternative treatments for her anxiety and sleep issues to improve her balance and overall well-being.