Diazepam and Lorazepam

Question 1

What are the indications for diazepam/lorazepam

Answer 1

Acute treatment of seizures/status epilepticus
Pre-eclampsia, anxiety, tetanus, dystonia
Sedation for procedures eg endoscopy

Question 2

What are the doses of diazepam/lorazepam in seizures?

Answer 2

4mg lorazepam iv is best as long lasting, if not then 5mg rectal diazepam.

Need a long lasting antiepileptic if giving diazepam iv

Question 3

What are the contraindications to benzodiazepines?

Answer 3

Ataxia
Renal or hepatic impairment
Psychosis, depression
Pregnancy - causes floppy infant syndrome
Acute alcohol/drug intoxication
Narrow angle glaucoma
Myaesthenia gravis

Sudden discontinuation as causes withdrawal

Question 4

What are the side effects of benzodiazepines?

Answer 4

Dependence

Amnesia, suppression of REM sleep, impaired motor function, dizziness, reflex tachycardia, depression

Question 5

Which medications interact with benzodiazepines?

Answer 5

Flumazenil
Other sedatives/hypnotics
OCP, cimetidine, erythromycin (cyp450) inhibit elimination

Diazepine affects L-DOPA and digoxin levels

Question 6

How are benzodiazepines eliminated?

Answer 6

CYP450 system

Question 7

What shouldn’t patients on benzodiazepines do?

Answer 7

Operate machinery, stop them suddenly

Question 8

How do diazepam and lorazepam work?

Answer 8

Benzodiazepines - GABAa receptor agonists, have a depressant effect on the CNS