Benzos baby

Question 1

Short acting benzos

Answer 1

OXazepam and the -OLAMS
ATOM

Alprazolam
Triazolam
Oxazepam
Midazolam

But really:
Midazolam 1-2 hours
Triazolam 2-4 hours

Oxazepam and Alprazolam 5-10 hours

Question 2

Intermediate acting benzos

Answer 2

AOL

Alprazolam
Oxazepam
Lorazepam

Alp and Ox 5-10 hours

Lorazepam 10-20 hours.

Question 3

Are short acting benzos more or less addictive than long acting

Answer 3

Short acting are more addictive and have the strongest withdrawal symtoms

Question 4

What are the long acting benzos

Answer 4

Diazepam, Chlordiazepoxide, Flurazepam
50-100 hours half life.

Flurazepam longest acting.

Question 5

Benzodiazepine indications

Answer 5

Acute seizures, epilepsy attacks, I.V. Lorazepam or Diazepam. 1st line drugs for Status Epilepticus.

Long acting benzodiazepines for alcohol withdrawal

Adjuct to general anesthisia

Or as the sole agent for conscious sedation and minor procedures.

Midazolam as an induction anesthesia agent.

Short term insomnia treatments

Short term sleepwalking or night terror treatment

Muscle relaxant, for patients with tremor from MS, stroke, SCI, central spasmolytic.

Acute treatment for panic attacks, not prophlyaxis

Prophylaxis treatment for Generalized Anxiety Disorder and Phobias. 2nd line after SSRIs.

Question 6

What is Status epilepticus

Answer 6

A single epileptic seizure lasting more than five minutes or two or more seizures within a five-minute period without a return to normal in between.

Question 7

What is the mechanism of Benzos

Answer 7

Bind to benzodiazepine receptor on the GABAa channel.

There are TWO BZ receptors

BZ1: mediates sedation and amnesia effects
BZ2: mediates anxiolytic effects.

Question 8

What are the I.V. benzos?

Answer 8

Diazepam, Lorazepam, and Midazolam

All the rest are oral.

Question 9

Benzo metabolism

Answer 9

All are liver metabolized,

Triazolam, Oxazepam, and Diazepam type breakdown pathways.

Question 10

Benzo side effects

Answer 10

Especially for Eldery:
Impaired cognition and confusion
Sedation
Ataxia
Amnesia

Sleep disturbances,
‘non-physiological sleep cycle’ They alter the REM cycles, and decrease overall REM sleep.
Exacerbate sleep apnea

Nobody should drive on benzos, even at low doses.

They all cause tolerance and addiction and withdrawal.

Withdrawal symptoms are similar to alcohol withdrawal.

Paradoxical seizures in some cases

Overdose symptoms:
Cardiorespiratory suppression, coma, death.

Question 11

Treatment for BZ overdose

Answer 11

Flumazenil.