Benzodiazepines Flashcards

1
Q

What is the mechanism of action of benzodiazepines?

A

Bind to alpha subunit of GABA receptor on chloride channels thereby increasing the affinity for GABA. This leads to an increase in the frequency with which chloride channels open.

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2
Q

What are the clinical properties of benzodiazepines that they are used?

A

Sedation

Hypnotic

Anxiolytic

Anticonvulsant

Muscle relaxant

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3
Q

Benzodiazepines can be short acting, medium acting or long acting based on half-life. Give an example of a commonly used short acting benzodiazepine.

A

Midazolam

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4
Q

Benzodiazepines can be short acting, medium acting or long acting based on half-life. Give an example of a commonly used medium acting benzodiazepine.

A

Lorazepam

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5
Q

Benzodiazepines can be short acting, medium acting or long acting based on half-life. Give an example of a commonly used long acting benzodiazepine.

A

Diazepam

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6
Q

Why are benzodiazepines not prescribed long term?

A

Patients commonly develop tolerance and dependence to benzodiazepines.

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7
Q

What are the guidelines surrounding the withdrawal of benzodiazepines?

A

Dose should be reduced in steps of about 1/8th every fortnight.

A suggested protocol for patients experiencing difficulty is given:

  • Switch patients to the equivalent dose of diazepam
  • Reduce dose of diazepam every 2-3 weeks in steps of 2 or 2.5 mg
  • Time needed for withdrawal can vary from 4 weeks to a year or more
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8
Q

What are the clinical features of benzodiazepine withdrawal syndrome?

A

Very similar to alcohol withdrawal syndrome:

Insomnia

Irritability

Anxiety

Tremor

Loss of apetite

Tinnitus

Perspiration

Perceptual disturbance

Seizures

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9
Q

What are the conditions that benzodiazepines are used in?

A

Status epilepticus

Alcohol withdrawal

Restless leg syndrome

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10
Q

In which groups of patients are benzodiazepines contraindicated?

A

Breast feeding women

Can precipitate attack in those with acute intermittent porphyria

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11
Q

What are the early features of benzodiazepine toxicity?

A

Early signs (much like being drunk):

Intoxication

Somnolence (drowsy)

Diplopia

Impaired balance

Impaired motor function

Anterograde amnesia

Ataxia

Slurred speech

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12
Q

What are the later more severe features of benzodiazepine toxicity?

A

Prolonged deep coma or deep cyclic coma

Apnea or respiratory depression

Hypoxemia

Hypothermia

Hypotension

Bradycardia

Cardiac arrest

Pulmonary aspiration

Death

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13
Q

How do we medically manage someone who has taken an overdose of benzodiazepines?

A

Flumazenil

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