Benzos for Bozos Flashcards

1
Q

Three most commonly used benzos in our practice?

A

Midazolam (Versed), Lorazepam (Ativan), and Diazepam (Valium)

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2
Q

Order of potency of top 3 benzos?

A

Lorazepam > Midazolam > Diazepam

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3
Q

What determines potency of benzos?

A

Receptor binding affinity (all are highly lipophilic and protein-bound)

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4
Q

General chemical structure of benzos?

A

Benzene ring fused to 7-member diazepine ring, 2 Ns @ 1 & 4, phenyl @ 5

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5
Q

On which receptors do benzos work?

A

GABA receptor complex (alpha subunits); allows Cl- to pass inside neuron, making cell more negative, decreasing response (inhibitory) to other neurotransmitters.

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6
Q

Do benzos produce amnesia?

A

Yes, yes they do. They produce anterograde amnesia.

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7
Q

What do you know about the amnesia produced by benzos?

A

Doesn’t affect previously formed memories; does not affect short-term memory, but memories are likely are not transferred to long-term memory. Memory impairment may be more pronounced in IV administration, high dose, slow elim., and accumulation of drug.

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8
Q

Does the high protein-binding of benzos affect distribution and effect?

A

Yes. Hypoalbuminemia leads to increased levels of free drug in the plasma, leading to greater distribution and effect.

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9
Q

Desired effects of benzos:

A

Anterograde amnesia

Sedation/hypnotic

Anxiolytic

Anticonvulsant

Skeletal muscle relaxant

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10
Q

Side effects of benzos that are not necessarily desired:

A

Decr. CMRO2 and CBF

Do not increase or decrease ICP

Minimal depression of ventilation

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11
Q

How do elderly folks do with benzos?

A

They are more sensitive.

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12
Q

Benzos have _______ effects with other drugs like opioids and propofol.

A

synergistic

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13
Q

What are indications for benzos?

A

Sedation

Anesthesia induction

Anesthesia maintenance

Anticonvulsant

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14
Q

Benzos metabolized:

A

In the liver (1st order kinetics):
-Midaz: CYP450 3A4 (phase I)

  • Diaz: N-demthylation (phase I)
  • Loraz: glucuronic acid conjugation (phase II)
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15
Q

Benzos _____ MAC of VAAs.

A

decrease (by 30%)

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16
Q

Diazepam: Onset/Peak/Duration

A

30-60 min PO/ 1-2 hrs/ 48-96 hrs

17
Q

Lorazepam: Onset/Peak/Duration

A

1-2 mins (IV)/ 20-30 min/ 6-10 hr

18
Q

Midazolam (Versed) dose, onset, peak, duration?

A

dose: 0.2 - 0.4 mg/kg
onset: 30-60 seconds
peak: 3-5 minutes
duration: 15 - 30 minutes

19
Q

Reversal for benzos?

A

flumazenil (Romazicon)

20
Q

How does that flumazenil stuff work?

A

Competative antagonism; watch for resedation, lasts for about 15 mins, does not reverse ETOH or barbs.

21
Q

Does midazolam cross the blood brain barrier?

A

yes

22
Q

Flumazenil (Romazicon) dose, max dose, onset, peak, duration?

A

dose: 0.2 mg (8 - 15 mcg/kg). further doses of 0.1 mg may be given at 60 second intervals

max dose: 1 mg

onset: < 1 minute
duration: 30 - 60 minutes (per the M&M book)

(no peak time)

23
Q

How is flumazenil (Romazicon) metabolized and eliminated?

A

hepatic metabolism

renal elimination