Benzodiazepines

Question 1

how are benzodiazepens classified ?
name Benzodiazepens for each category
(“Ben’s Diner”)

Answer 1

-have “PAM-suffix
(“Pam-cakes in Ben’s diner”)

-have “OLAM-suffix”
(“pamcakes offered ALL A.M.”)
——————————————————————————–
Short acting Benzodiazepens -“ATOM”

Triaz-olam
Oxaze-pam (“fast ox”)
Midaz-olam
——————————————————————————–
Intermediate acting Benzodiazpenes “lora the clown”
Loraze-pam
Alpraz-olam
Clonaze-pam
——————————————————————————–
Long acting Benzodiazpenes
Diaze-pam
Fluraze-pam

Question 2

Benzodiazpenes MOA

(“Ben’s Diner”)

Answer 2

-bind to an allosteric site on GABA-A Receptor
(“Ben’s diner coworker handing the Cab-A driver Pamcakes”)

-GABA-A receptor is a chloride channel, chloride influx hyperpolarizes nerve cells
(“chlo-rider” sign on Cab-A)

-Benzodiazpenes increase the Frequency of opening of the chloride channel
(ben’s diner is :”now open more frequently”)

-potentiates (enhance) transmission of GABA in CNS
(“Red CNS light on Cab-A”)

-GABA is the major inhibitory neurotransmitter in the CNS (the sign on Cab-A says “take it easy” )

-metabolized by the liver and produce long acting active metabolites
(“fast ox has liver spot on him”)

-have addictive potential
(“Ben’s Diner pamcakes have addictive flavour”)

Question 3

what are Benzodiazepens used for ?

(“Ben’s Diner”)

Answer 3

-IV adminstration of Benzodizapenes are useful in managment of alcohol withdrawl , seizures , anesthesia (“Ivy on pole”)

-IV adminstration of Benzos can be used for general anesthesia
(“green shirt sedated customer with straw in mouth”)

-IV adminstration of Benzos is useful to induce
conscious sedation for minor procedures ,e.g.-colonoscopy
(cup saying “lite” infront of sedated customer)
——————————————————————————–
-useful for treatment of status epilepticus
(“coworker unplugging jackhammer”)

• can treat insomnia (“customer sleeping on table”)
• **not 1st line due to physical dependence**

-can treat Parasomnias in children
(“crying kid in pajamas”)

-benzos are muscle relaxants used to treat Spasticity cause by upper motor neuron disorders
(“red shirt blacky relaxed on diner’s bench”)

• useful in treatment of General Anxiety Disorder {G.A.D}
• *SSRIs/SNRIs are 1st line

(“Anxious cutsomer not sure if he can pay for the date lool”)

• Benzos are useful for treating Panic disorder
• *SSRIs/SNRIs are 1st line

Question 4

what are the alcohol withdrawal symptoms

? what role do Benzos have in treating alcohol withdrawal

Answer 4

-alcohol also binds GABA-A receptor but on a different allosteric site
(“alcoholic guy is on back of Cab-A”)

-Benzos are useful in treatment of alcohol withrdawl symptoms (“hangover special pamcakes”)

• especially long acting Benzos such as Diazepam and Chlordiazepoxide
  (“Long tapering flag on hangover special pamcakes”)
• ​for patients with hepatic insufficiency use short-acting Benzos

​Alcohol Withdrawal symptoms -“3 alcohol specialists”

1st specialist (8-12 hours) - insomnia ,tremulousness , anxiety , autonomic instability

2nd specialist (12-48 hours) - Seizures

_3rd specialist (_48-96 hours)-**delirium tremens** 
(fever ,disorientation , severe agitation )

Question 5

Benzodiazepens side effects

Answer 5

-can potentially cause addiction
(pam-cakes have “addictive flavour”)

-can cause tolerance (“all are welcome” sign in Ben’s Diner)

-Benzodiazepens can cause Anterograde Amnesia and learning impairment
(“question mark hat on sedated customers head”)

• useful for conscious sedation so patient will follow orders but will forget unpleasant procedure afterwards
• Benzos can cause Central Ataxia causing elderly patient to fall

(“unbalanced stack of pamcakes infront of old fart”)

-elderly patients are more sensitive for Benzos side effects (“disoriented man sitting infront of stack of unbalanced pamcakes”)

• adminstration of Benzos should be avoided with other CNS depressants such as 1st generation antihistamines
  (“coworker with bee swatter smacks old fart customer”)

Question 6

what is the key difference between Benzodiazepens and Barbiturates

Answer 6

-the difference between them is that Barbiturates bind different allosteric site on GABA-A receptors

(“barber shop located on other side of Cab-A”)

Question 7

How can you reverse Benzodiazepens-induced sedation

Answer 7

-Flumazenil is a competitive antagonist at the BZD receptor and can reverse Benzos-induced sedation

(“violent-antagonizing fluffy muzzled dog”)