Pharm Benzos

Question 1

Names of benzos

Answer 1

Librium 
Diazepam
Serax
Lorazepam
Midazolam-1976

Question 2

Moa benzos

Answer 2

Activation of GABAA receptor complex and enhancement of gaba mediated chloride currents
Neurons hyper polarized and less excitable
GABA continues to bind and is needed to work

Question 3

Benzo that has best affinity and efficacy

Answer 3

Midazolam

Question 4

Benzo moa almost exclusively on post synaptic nerve endings in CNS, the greatest density is in the?

Answer 4

Cerebral cortex,

Question 5

Effects of benzos with corresponding area of brain

Answer 5

Anxiolytic- amygdala, hippocampus, límbico áreas
Sedation- brain stem and cortical receptors
Anticonvulsant
Muscle relaxation- spinal cord
Amnesia-forebrain and hippocampus

Question 6

Benzos vs barbs

Answer 6

Less tolerance
Less abuse potential
Greater margin of safety against overdose
Fewer and less dig drug interactions
Do not induce enzymes

Question 7

Less tolerance?

Answer 7

Not sure if true, data from pt reported

Question 8

Imidazole ring at pH 4?

Answer 8

Basic formulation water soluble, does not require lipid vehicle(like propofol)
Open ring

Question 9

Imidazole ring at pH of body

Answer 9

Ring closes and midazolam becomes lipophilic

Question 10

Despite rapid passage into the brain, midazolam has a ______ effect site equilibrium. _______ protein bound.

Answer 10

Slower, highly

Question 11

Benzo CNS effects

Answer 11

Decrease CMRO2 and CBF(lesser extent than barbs)
Cannot produce isoelectric (flat) eeg
Little to no change in icp
Potent anticonvulsant
Paradoxical excitement occurs in <1% of pts receiving versed

Question 12

Cv system effects

Answer 12

Dose dependent decrease in systemic blood pressure
CO is not changed ( why no change in ICP)
BP response d/t decrease SVR
Does not prevent sympathetic response with intubation

Question 13

Respiratory effects benzos

Answer 13

Minimal, does dependent decrease in ventilation
Decrease in vent response to co2(effect chemoreceptors)
Transient apnea after rapid IV dose(synergistic and additive with opioids) worst with sleep apnea
Depression of swallowing reflex
Decrease in upper airway activity

Question 14

Side effect benzo

Answer 14

Allergic reactions- extremely rare
Anterograde amnesia
Ativan infusions not recommended d/t propylene glycol cause cardiovascular complications
Over sedation SLEEP NOT RESTORATIVE

Question 15

Cause for pain on injection of diazepam and Ativan

Answer 15

Propylene glycol solvent

Question 16

How long can withdrawal of benzo last?

Answer 16

Weeks to months

Question 17

Withdrawal symptoms benzo CNS and cardio

Answer 17

CNS: anxiety, insomnia, seizures, coma, agitation, mania, psychosis, suicide
Cardio: htn, tachycardia, postural hypotension

Can die
Restart mês and taper

Question 18

Benzo reversal agent and administration

Answer 18

Flumazenil- benzo antagonist -competitive

200mcg every 1-2min to max of 3mg per hour

Question 19

Who would you not give flumazenil to?

Answer 19

Chronic benzo user overdose, put them into seizure withdrawals

Question 20

Remimazolam

Answer 20

New benzo pending
Metabolism via este rases
Rapid clearance
Less accumulation