Benzos

Question 1

why are barbiturates more toxic than benzos

Answer 1

barbs allosterically hold channel open so unlimited cna go through
benzos allow greater frquency for ion channel to open so only a certain amount can go through at a time

Question 2

predisposing factors for benzo od

Answer 2

age
hepatic impairment
COPD

Question 3

cns effects

Answer 3

mild - drosy, lethargy within 30min
moderate -slurred speech, amnesia, ataxia
severe - stupor or coma (hypothermia, hyporeflexia, miosis)
rare paradoxical reactions - agitation, aggression, condusion

Question 4

respiratory effects

Answer 4

resp depression parallels cns depression, but not always

hypoventilation

Question 5

cardiovascular effects

Answer 5

non ein benzo and z drugs
postural hypotension or bradycardia in high risk
cardiovascular collapse rare

Question 6

unholy trinity

Answer 6

benzos
opioids
skeletal muscle relaxant

Question 7

possible risk factors

Answer 7

elderly 
on opiods
benzo niave
high dose
copd 
emotional distress 
undetected depression/suicidal

Question 8

treatment of od

Answer 8

supportive measures
activated charcoal for poly drug overdose
urinary alkalinization for barbiturates
hemodialysis doesnt work??

Question 9

antidote

Answer 9

flumazenil

Question 10

flumazenil moa

Answer 10

competitive antagonist of bz receptor

reverses bzd induced cns depression but can induce withdrawal

Question 11

when do you use flumazenil

Answer 11

benzo naive pts with benzo only overdose

Question 12

dose of flumazenil

Answer 12

1.-.2mg iv over 20sec
subsequent doses of 0.3mg and 0,5mg at 1 min interval up to 3mg total
very short acting

Question 13

flumazenil contraindication

Answer 13

physically dependent (withdrawal)
benzo for control of seizure disorder
cardiac arrythmia or high risk of arrhythmia
coingestion of agents causing seizures (TCA)
increased intracranial pressure (seizure risk)
unknown history

Question 14

ideal scenario for flumazenil

Answer 14

pure benzo overdose in nontolerant individual who has 
CNS depression, 
normal vital signs
normal ECG
normal neurological exam

Question 15

chronic use issues

Answer 15

tolerance and dependence during continuous use and withdrawal after cessation

Question 16

pharmacotherapy substitutions

Answer 16

longer acting beno
pregabalin 
carbamazepine
melatonin 
flumazenil patch

Question 17

treating benzo dependency

Answer 17

gradual dose reduciton + behavioral or psychological interventions
swithc agent

Question 18

gradual dose reduction regimen

Answer 18

decreased dose 10-25% every 1-2 weeks

usually dont have to switch to long acting benzo

Question 19

short half life benzos

Answer 19

increased tolerance and dependence
midazolam
triazolam

Question 20

long acting benzos

Answer 20

diazepam

secreted in breast milk

Question 21

managing benzo od

Answer 21

protect airways, assist ventilation
treat coma - glucose, thiamin, naloxone
treat hypotension - fluids, epinephrine
treat hypothermia - warm them up

Question 22

benzo tolerance

Answer 22

tolerance to sedative and antianxiety effect

cross tolerance - alcohol, barbiturate

Question 23

chronic toxicity of benzo

Answer 23

no organ damamge
tolerance, dependence, withdrawal
lower dependence than other sedative agents

Question 24

benzo withdrawal symptoms

Answer 24

mild: anxiety, insomnia, tremor
major: seizure, psychosis, delirium