BZD OD Flashcards
MoA of BZDs
bind to the benzo receptor on the chloride channel and helps facilitate GABA binding to the chloride channel → once GABA binds → chloride channel opens → chloride flows through and causes inhibition of CNS
BZD withdrawal symptoms
severe sleep disturbance, irritability, increased tension and anxiety, panic attacks, sweating, difficulty in concentration, dry retching and nausea, palpitations, HA, psychotic reaction, seizures (can be lethal if not stopped abruptly → status epilepticus!)
BZD OD antidote and adult dosing
Flumazenil 0.2mg IV over 15 minutes for adults
BZD OD antidote peds dosing
Flumazenil 0.01mg/kg IV
MoA of flumazenil
Competitive antagonist at the BZD receptor site
Onset of action for flumazenil
1-2 mins
Duration of action for flumazenil
Varies; re-dosing may be necessary so monitor patients!
If you die from a BZD OD, it’s because of what?
You lost the airway
Flumazenil and respiratory depression
Flumazenil will knock the benzodiazepine off the receptor but it might not reverse the respiratory depression
Polysubstance OD: elimination strategy
AC
Polysubstance OD: example of an antidote
NAC
Polysubstance OD: supportive care
BZDs
Advantages of BZDs in a polysubstance OD
Large protective effect, high therapeutic index, and can treat a number of different things when we don’t know what the patient OD’ed on
Controversy around flumazenil
You give it in a BZD OD, so if you reverse it, you unmask other things the patient could’ve possible OD’ed on…but the problem is that you’d just give BZDs again to treat THOSE drug ODs and reverse the protective effect
When is it safe to give flumazenil?
Procedural sedation (assuming the patient isn’t BZD-dependent, no seizure risk, no epilepsy history)
Unintentional, pediatric exposure
