Benzodiazepine

Question 1

Benzodiazepine - examples

Answer 1

diazepam

lorazepam

midazolam

Question 2

Benzodiazepine - indications

Answer 2

1) first-line for seizures and status epilepticus
2) first-line for alcohol withdrawal reactions
3) short-term for disabling anxiety/insomnia (e.g.- in acute reaction to stress disorder)

Question 3

Benzodiazepine - adverse effects

Answer 3

1) dose-dependent drowsiness, sedation and coma
2) benzodiazepine overdose = airway obstruction and death
3) dependence
4) abrupt cessation = withdrawal reaction

Question 4

Benzodiazepine - cautions and contraindications

Answer 4

CAUTION
1) elderly - use lower doses

AVOID
1) respiratory impairment

2) neuromuscular disease

3) liver failure (if use is necessary in these patients use lorazepam as its clearance depends less on the liver)
Remember L = lorazepam = liver

Question 5

Benzodiazepine - interactions

Answer 5

1) opioids (due to additive effect)

2) CYP inhibitors - amiodarone, diltiazem, macrolides, fluconazole

Question 6

Benzodiazepine - what are examples of short-acting and long-acting benzodiazepines?

Answer 6

short-acting: lorazepam

long-acting: diazepam and chlordiazepoxide

Question 7

What is an example of when long-acting benzodiazepines are used?

Answer 7

In alcohol withdrawal long-acting benzos are used - diazepam OR chlordiazepoxide

However - lorazepam (short-acting) is preferred in hepatic failure patients