Benzodiazepines and flumazenil

Question 1

Benzodiazepine names

Answer 1

(best PAM-cakes in town)
diazepam
lorazepam
oxazepam

Question 2

short acting Benzodiazepine

Answer 2

oxazepam 
(better act fast ox)
triazolam
alprazolam
midazolam
(pam cakes ALL AM )

Question 3

long acting Benzodiazepines

Answer 3

diazepam

chlordiazepoxide

Question 4

side effects of short acting Benzodiazepines

Answer 4

short serum half life = more likely to cause physical dependence and addiction (addictive flavor next to ox)

Question 5

how Benzodiazepines are metabolized

Answer 5

by the liver (liver spot on ox)

long acting agents form active metabolites they have long half lives

Question 6

uses of Benzodiazepines

Answer 6

Alcohol withdrawal - long acting benzos (long tapering flag on pancakes in front of withdrawal guys)
IV admin for alcohol withdrawal, seizures/status epilepticus, general light anesthesia/muscle relaxation and anterograde amnesia (IV next to seizing worker, sleeping guy with straw/intubated)
Insomnia but not first line (sleeping guy)
parasomnia/sleepwalking/night terrors in kids (crying kid in pjs)
spasticity caused by UMN diseases - MS, stroke, SC trauma, tetanus (relaxed guy)
anxiety disorders and panic disorder but not first line (anxious guy, scream painting)

Question 7

how Benzodiazepines work

Answer 7

they bind to an allosteric site on the GABA-A receptor to increase inhibition in the CNS (handover of pancakes at Cab-A)
the GABA-A receptor is a chloride channel (Chlo-Rider cab) and benzo binding increases the frequency of ion channel opening (open more frequently sign)

Question 8

things that bind the GABA-A receptor

Answer 8

Benzodiazepines
Alcohol (drunk guy on cab)
Barbiturates (barber shop person getting in cab)
*all at different allosteric sites

Question 9

alcohol withdrawal symptoms

Answer 9

8-12 hours: insomnia, tremor, anxiety, autonomic instability (tachycardia, sweating) (anxious sweaty guy with hand tremor)
12-48 hours: seizures (seizing guy)
48-96 hours: delirium tremens - fever, disorientation, severe agitation (agitated/angry guy)

Question 10

Benzodiazepine side effects

Answer 10

tolerance due to down regulation of GABA-A receptors (all are welcome - tolerance sign)
anterograde amnesia
somnolence, confusion, disorientation, ataxia/falls especially in the elderly (disoriented older man next to falling stack of pancakes)

Question 11

Benzodiazepine interactions

Answer 11

first gen antihistamines (bee swatter) 
CNS depressants (alcohol, barbiturates, neuroleptics)

Question 12

reversing Benzodiazepine induced sedation

Answer 12

flumazenil (fluffy muzzled dog)
competitive antagonist at the GABA-A receptor
can precipitate seizures especially in people with tolerance