Benzos

Question 1

What is anxiety?

Answer 1

sustained state of apprehension and autonomic arousal in response to real or perceived threats. Fear of suffering and death, loss of control, and frustration caused by the inability to communicate

Question 2

What is the onset of midazolam

Answer 2

30-60 seconds

Question 3

What are the symptoms of anxiety?

Answer 3

headach, insomnia, nausea, anorexia, dyspnea, palpitations, dizziness, dry mouth and chest pain.

Signs include diaphoresis, hyperventilation, tachycardia, etc

Question 4

what is the duration of midazolam?

Answer 4

15-80 min

Question 5

what is the peak time of midazolam?

Answer 5

3-5 min

Question 6

What is the route and trade name for for lorazepam?

Answer 6

Ativan

iIV

Question 7

What is the onset of Lorazepam?

Answer 7

1-2 minutes

Question 8

what is the peak time of lorazepam?

Answer 8

20-30 minutes

Question 9

what is the duration of lorazepam?

Answer 9

6-10 hours

Question 10

What is the route for diazepam

Answer 10

po. occasionall used in preop

Question 11

What are the effects of benzodiapines?

Answer 11

Sedation

Anxiolysis

Anticonvulsant

Anterograde amnesia

Question 12

Do benzodiazepines protect against the stress of intubation or provide anagesia?

Answer 12

no

Also not useful as an antidepressant or antipsychotic

Question 13

How are benzo diazepines used clinically?

Answer 13

Relief of anxiety

Sedation and amnesia before and during medical and surgical procedures

component of balanced anesthesia

Treatment of epilepsy and siezures

Insomnia

Control of ethanol or other sedative-hypnotic withdrawal states

muscle relaxaition in specific neuromuscular disorders

diagnostic aids for treatment in psychiatry

Question 14

What is the mechanism of action for benzodiazepines?

Answer 14

Benzodiazepines work in post synaptic neurons by binding to the GABAa receptor. This receptor opens chloride channels and hyperpolarizes the neuron increasing the difference btw resting potential and action potential making firing less likely.

their action works in these areas:

Cerebral cortex>hypothalamus>midbrain>hippocampus>medulla>spinal cord

Question 15

What is the effectif 20% of receptors are bound by a benzodiazepine?

Answer 15

axiolysis

Question 16

What is the effect if 20-50% of receptors are bound by benzodiazepine?

Answer 16

sedation

Question 17

What is the effect if 60% of receptors are bound by benzodiazepine?

Answer 17

uncosciousness

Question 18

What is the preop dose of midazolam for kids?

Answer 18

0.5 mg/kg PO 30 minutes before

15 mg max

Question 19

What is the IV sedation dose for midazolam?

Answer 19

0.5-4 mg IV load, followed by 1-7mg/hour

Question 20

What is the dose of midazolam for IV induction of anesthesia?

Answer 20

0.1-0.2 mg/kg

Question 21

What dose of Diazepam used for supression of seizure activity?

Answer 21

0.1 mg/kg

Question 22

Are benzodiazepine subject to cross tolerance?

Answer 22

yes. Alcohol also binds GABAa

Question 23

How does hypoalbumenia affect benzodiapines?

Answer 23

Benzos are bound to protein 90-98%. In the case of hypoalbunemia you have more free drug and an increased effect

Question 24

How is midazolam metabolized?

Answer 24

liver oxidation by CYP450

Question 25

How does alcohol use affect midazolam metabolism?

Answer 25

Alcohol increases tolerance due to GABAa ase well as leads to increased clearance

Question 26

What is the active metabolite for midazolam?

Answer 26

there is none

Question 27

How does age affect midiazolam?

Answer 27

in elderly \>80yo -dysphoria, impaired cognitive function, and effects last long

Question 28

How is versed for end stage renal disease?

Answer 28

versed metabolites are excreted in urine. Because versed has no active metabolites, it will have no effect on these pts.

Question 29

What effects do benzos have on the CNS?

Answer 29

decreased cerebral metabolic O2 requirement and decreased cerbral blood flow No isoelectric EEG No change in ICP No evidence of neuroprotection Potent anticonvulsant

Question 30

What effects do benzos have on ventilation?

Answer 30

dose dependent decrease

Question 31

What effects do benzos have on the CV system?

Answer 31

decrease BP and HR--minor

Question 32

Do benzos cross the placenta?

Answer 32

YES

Question 33

What are hepatic considerations for taking benzos

Answer 33

cross reactions with other drugs age--elderly will not have as much blood flow to the liver

Question 34

How do benzos work as anti convulsants?

Answer 34

ability ot facilitate the actions of GABA (barbituates depress the CNS)

Question 35

What is the dose of diazepam for lidocaine toxicity, DTs and status epilepticus?

Answer 35

0.1mg/kg IV

Question 36

What is the pK of versed?

Answer 36

6.15

Question 37

How does versed compare to Diazepam?

Answer 37

2-3x as potent

Question 38

What are reasons versed is good for anesthesia?

Answer 38

Rapid onset Short duration Specific andtagonist PO route

Question 39

What are problems with Valium and Ativan in for anesthesia?

Answer 39

not water soluble-have preservative and additives and can cause thrombophlebitis and venous irritation Active metabolites--this will increase effect in end stage renal disease Slow onset long duration

Question 40

What is flunitrazepam?

Answer 40

rohypnol

Question 41

What is flumazenil?

Answer 41

Specific competitive antagonist for benzos

Question 42

What are potential problems of flumazenil?

Answer 42

Resedation-only has 30 minute duration Withdrawl if chronically on benzos

Question 43

How is flumazenil metabolized?

Answer 43

in liver

Question 44

Wha tis the dosing for flumazenil?

Answer 44

0.1-0.2 mg IV repeated up to 3 mg

Question 45

What percent of versed makes it to the BS after redistribution?

Answer 45

50%