Benzodiazepines

Question 1

Name 11 Benzodiazepines.

Answer 1

1. Alprazolam
2. Bromazepam
3. cloBAZam
4. CLONazepam
5. Diazepam
6. Flunitrazepam
7. LORazepam
8. Midazolam
9. Nitrazepam
10. OXazepam
11. Temazepam

Question 2

Describe the half-life of nitrazepam.

Answer 2

Nitrazepam has a long half-life.

Question 3

Describe the half-life of midazolam.

Answer 3

Midazolam has a very short half-life

Question 4

Describe the half-life of alprazolam.

Answer 4

Alprazolam has a short half-life

Question 5

Describe the half-life of OXazepam.

Answer 5

OXazepam has a short half-life

Question 6

Describe the half-life of temazepam.

Answer 6

Temazepam has a short half-life

Question 7

Describe the half-life of bromazepam.

Answer 7

Bromazepam has a moderate half-life

Question 8

Describe the half-life of LORazepam.

Answer 8

LORazepam has a moderate half-life

Question 9

Describe the half-life of cloBAZam.

Answer 9

cloBAZam has a long half-life

Question 10

Describe the half-life of CLONazepam.

Answer 10

CLONazepam has a long half-life

Question 11

Describe the half-life of Diazepam.

Answer 11

Diazepam has a long half-life.

Question 12

Describe the half-life of flunitrazepam.

Answer 12

Flunitrazepam has a long half-life.

Question 13

Describe the benzodiazepine loading dose technique in the management of alcohol withdrawal.

Answer 13

The patient is given repeated doses of diazepam until symptoms have diminished to an acceptable level.

Question 14

Describe the role of diazepam in alcohol withdrawal.

Answer 14

Diazepam is effective in the prevention and treatment of acute alcohol withdrawal seizures.

Question 15

Can diazepam be used as monotherapy in alcohol withdrawal relief? Why/why not?

Answer 15

Because of the relatively large doses usually given, and the long half-life of diazepam, it may not be necessary to give any further medication for withdrawal relief.

Question 16

What is the usual regimen for diazepam in alcohol withdrawal?

Answer 16

Use diazepam 20 mg orally, every 2 hours until symptoms subside. A cumulative dose of 60 mg daily is usually adequate.

Question 17

If a patient with alcohol withdrawal has not settled with 60 mg diazepam, what should be done?

Answer 17

Review the diagnosis and consider the possibility of other conditions.

Question 18

What is the upper limit of diazepam dosing for alcohol withdrawal.

Answer 18

Do not exceed 100 mg daily without seeking specialist advice.

Question 19

Describe the duration of diazepam administration for alcohol withdrawal.

Answer 19

Diazepam may be administered over the subsequent 2 to 7 days if symptoms return but should not be continued beyond that.

Question 20

What should be done if diazepam is needed by a patient undergoing home treatment for alcohol withdrawal?

Answer 20

If diazepam is needed, it can be collected daily by the patient or administration can be supervised by a reliable person living with the patient.

Question 21

Describe the role of high-dose diazepam in alcohol withdrawal delirium (delirium tremens).

Answer 21

Very high doses of diazepam (greater than 100 mg daily) may be required, but seek specialist advice.

Question 22

Describe the role of IV diazepam in alcohol withdrawal delirium (delirium tremens).

Answer 22

Intravenous injection of diazepam should be avoided if possible. Onset of action is not much faster than with oral administration and there is a greater likelihood of causing severe adverse effects such as respiratory depression.

Question 23

What should be done if an injection of diazepam is necessary in the management of alcohol withdrawal delirium (delirium tremens).

Answer 23

If an injection of diazepam is necessary, it must not be diluted and it must be given slowly over several minutes to minimise the risk of respiratory depression or arrest. Close cardiorespiratory monitoring is essential.

Question 24

What is an alternative to diazepam injections in alcohol withdrawal delirium (delirium tremens)?

Answer 24

Cautiously use parenteral midazolam as given for agitation in severe acute behavioural disturbance.

Question 25

What is a risk associated with diazepam and, to a lesser extent, haloperidol and droperidol in alcohol withdrawal delirium (delirium tremens)?

Answer 25

They may worsen symptoms of hepatic encephalopathy.