200 benzodiazepines

Question 1

Benzodiazepines

Class MOA,s/s

Answer 1

MOA

bind to specific sites on GABA type A receptors. GABA is the major inhibitory neurotransmitter of the CNS. Benzos precipitate effects of GABA. Increased GABA causes sedation giving them their hypnotic, anxiolytic, and anticonvulsant effects GABA is the chief inhibitory neurotransmitter in the mammalian central nervous system. Its role is in reducing neuronal excitability and, in humans, it is also responsible for the regulation of muscle tone. If your nervous system was a car, GABA functions much like the “brakes”. When the “car” takes off speeding down the road (excitability of the nervous system), GABA functions as the “brakes” to calm and slow it down.

Simply put, GABA sends its inhibitory message by binding at special sites called GABA-A receptors on the outside of the receiving neuron. Once GABA is bound to the GABA-A receptor, the neuron opens a channel that allows chloride ions to pass inside of the neuron. These negative chloride ions make the neuron less responsive to other neurotransmitters (norepinephrine [noradrenaline], serotonin, acetylcholine, and dopamine) which would normally excite it. Benzodiazepines also bind to their own receptors (benzodiazepine receptors) that are situated on the GABA-A receptor. The combination of a benzodiazepine at this site acts as a booster to the actions of GABA, allowing more chloride ions to enter the neuron, making it even more resistant to excitation.

IND

• seizures
• sedation
• anxiety

contra

• substance abuse(relative)
• CNS depressed head injury
• sever resp depression
• shock

s/s:

• ALOC
• RESP depression
• hypotension
• amnesia
• N/V
• headache

Question 2

Diazepam

name/dose/notes

Answer 2

Name

di-az-epam

VALIUM

dose

• seizures 1mgSIVP/IO q 2-5min max 10mg
• cardioversion sedation 5-15mg SIVP/IO 5-10min prior
• acute anxiety 2-5mg SIVP/IO/IM

notes:

Using large veins, can cause necrosis

incompatible with most fluids, use N/S

flumazenil is the antiodote

Question 3

lorazepam

name/dose/notes

Answer 3

name

lor-az-epam

ATIVAN

• seizures
• 0.5-2.0mg SIVP/IO/IN over 2-10min repeat 15-20min max 8mg
• sedation/anxiety/analgesia
• 1-4mg IM
• 0.44mg/kg IV/IO
• 1mg tab SL

notes

• should be diluted in NS or D5W
• binds to receptors outside the cell due to being water-soluble
• short ½ life the diazepam but same onset
• iv lorazepam can be out of the fridge for 6 weeks
• flumazenil is antiodote

Question 4

midazolam

name/dose/notes

Answer 4

name

mid-az-olam (olam not epam)

VERSED

• sedation/seizures
• 1-2.5mg SIVP/Io repeat PRN max 0.1mg/kg
• RSI
• 0.1-0.3mg/kg max 10mg

notes

• 3-4 times more potent than diazepam and shorter-acting
• greater risk of resp depression
• flumazenil antidote