Benzodiazepines

Question 1

state the mechanism of action of the benzodiazepine drugs on the GABA receptor sites in the CNS

Answer 1

benzodiazepines work by facilitating the binding of the inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS. This slows down the CNS.

Question 2

list the pharmacologic effects on the CNS, cardiovascular and respiratory systems.

Answer 2

CNS: as dosage is increased–sedation to hypnosis to stupor
reduce anxiety through effects on the limbic system, promote sleep through effects on cortical areas (“biological clock”), induce muscle relaxation through working on supraspinal motor areas in the cerebellum.

Cardiovascular: oral-nothing
IV-produce profound hypotension and cardiac arrest

Respiratory–little or no depression of respiration. but if COPD or chronic disorder, benzos may worsen hypoventilation and hypoxemia. Also may exacerbate apneic episodes in sleep apnea pts.

Question 3

list the pharmacologic effects on the CNS, cardiovascular and respiratory systems.

Answer 3

CNS: lethargy, respiratory depression, enhancement of GABA to slow down the signals

CV: heart rate drops
Respiratory: can cause respiratory depression because they slow the breathing down.

Question 4

define acute toxicity and reversal with Flumazenil (Romazicon)

Answer 4

ORAL overdose: symptoms include: drowsiness, lethargy and confusion. CV and resp effects uncommon.
IV toxicity: profound hypotension, respiratory arrest, cardiac arrest.

reversal: IV admin over 15 seconds and repeated every minute PRN up to a 3mg dose at the most.
Flumazenil is a competitive benzo receptor antagonist. (competes for the same receptors)

Question 5

list therapeutic uses, adverse effects and drug interactions for
diazepam (Valium)

Answer 5

therapeutic uses: anxiety, seizures, muscle spasm, alcohol withdrawal, anesthesia induction

adverse effects: CNS depression, amnesia (forgetfulness of events after dosing), sleep driving, paradoxical effects, respiratory depression.

drug interactions: few, yet dangerous when combined with other CNS depressants—profound respiratory depression, coma, and death.

Question 6

list therapeutic uses, adverse effects, and drug interactions for alprazolam (Xanax)

Answer 6

therapeutic use: anxiety and panic disorder.

adverse effects: CNS depression, amnesia (forgetfulness of events after dosing), sleep driving, paradoxical effects, respiratory depression.

drug interactions: few, yet dangerous when combined with other CNS depressants—profound respiratory depression, coma, and death.

Question 7

explain conscious sedation with midazolam (versed) IV form.

benefits/risks?

Answer 7

advantages: minor surgeries and endoscopic procedures can be done with ease, the patient doesn’t need to go fully under anesthesia.
risks: dangerous cardiorespiratory effects—respiratory depression and cardiac arrest. the drug should only be used in a setting where careful cardiac monitoring can be performed. facilities for resuscitation must be immediately available.

Question 8

describe the use of propofol for anesthesia.

Answer 8

most widely used IV anesthetic.
indication for induction and maintenance of anesthesia. Can be used to also sedate patients who are undergoing mechanical ventilation, radiation therapy, and diagnostic procedures.
releases GABA–generalized CNS depression.