04.02 Benzodiazepines

Benzodiazepines. So, we gonna go over today the Benzodiazepine, one of the most widely used medications in the hospitals settings. First of all, let’s take a look at the mechanism of action of Benzodiazepines. So, we have a GABA, which is also called, the full name is Gamma-aminobutyric acid which is a neurotransmitter in our brain. In the brain. So, gamma neurotransmitter is actually inhibitory neurotransmitter in the brain. So, when your brain secretes this gamma neurotransmitter, it causes the sedation, it helps you relax, it relaxes your muscles, and also, the anticonvulsant effects. What it means, so, in your brain, when the neurons are firing, like, constantly, when this neurotransmitter releases, those firing rates of neurons will significantly decrease. So, it causes the decrease in electrical activity in brain as well. That’s why, it causes the anticonvulsant effect as well. So, basically, these benzodiazepine drugs, what it does, when you give this benzodiazepine drugs, it increases the effect and secretion of GABA in the brain. So, when you give this benzodiazepine medication, it increases the secretion of this GABA neurotransmitter in brain and it increases, it potentates the effect of GABA in our brain and will cause this more sedation, relaxation and decrease in neuron firing rate which is anti-convulsant effect in our brain. So, that’s how basically the benzodiazepine works.

There are many many use of this benzodiazepine. First of all, if you take a look at it, it is used as a anti-anxiety medication. So, if a patient has a generalized anxiety disorder or panic disorder, we can give this medication to help them calm and reduce their panic attacks as well. This medication is also used more often in critical care in hospital for sedation and for relaxation as well. This medication is also used for insomnia and sleep disorder since it causes the sedation and dizziness, it will help you feel relaxed and will help you sleep better. However, these medications has to be prescribed by the doctors/physician. This is not the over-the-counter medication because it has very very many side effects an also, this can actually make you dependent on this drug really badly. So, that’s why, this is kinda controlled substance as well. This medication, as we talked, this medication will decrease the neuron firing rate in our brain. So, that’s why these medications can be used for seizures as well. And one of the two medication we’ll talk about later in this video that we usually use for seizures in emergency. This medication is also used for the alcohol withdrawal symptoms. So, whenever some person comes to the hospital and they are alcoholic, they drinks a lot of alcohol at home. Now, suddenly, they are not gonna drink or they won’t be getting any alcohol in hospital. So, they will go to the alcohol withdrawal symptoms like agitation, tachycardia, and hypertension, they’ll be anxious all the time. So, these are the symptoms of alcohol withdrawal. These medications are widely used to these alcohol withdrawal symptoms for patient who has a long history of alcoholism and so forth. Alright, those are the indications.

What are the side effects? Alright. Many side effects. First of all, the CNS depression, Central Nervous System Depression. It can cause sedation, ataxia, decrease in cognitive function and so forth. Like, it decreases the CNS system. So, whenever you have a patient on this medication, you will really teach him like a, when you take this medication, avoid driving for sure, do not operate heavy machinery or do not do any kind of activity that in which you have to use your mind significantly. Because this one actually significantly decrease their ability to perform any kind of work that requires high cognitive functions. Since it also causes ataxia, so, if they need to do some small works, like it needs to be really careful, like in driving that requires really good skills. They can’t really focus and do really well. Now, this medication, if you give this medication in a high doses, it can cause the amnesia, it means it can impair their memory for short period of time. So, it can cause Anterograde amnesia. This medication can cause the respiratory depression. So, you have to be really careful when you give this medication to patient. However, these medications are kinda like safe, as first, we’ve talked about the respiratory depression. Like, you may have seen patient getting barbiturates, which is often used for seizures and anxiety, like those kind of stuff. But these medications are kinda safe compared to barbiturates in respiratory depression. You have to give this medication in really really high dose in order to cause respiratory depression compared to barbiturates. But it still can cause respiratory depression. This medication can cause a significant hypotension, cardiac or respiratory arrest. Now, sometime, if a patient is on this medication and they suddenly stops, like if they are taking this medication for 6 months / 12 months and they suddenly stops, this can cause the paradoxical response. So, it can cause the opposite. So, it can cause a very bad insomnia, excitation, euphoria and anxiety. So, you don’t really wanna suddenly stop these medications as well. You wanna teach patient about that too. Like, do not suddenly stop this medication because it can cause the paradoxical response. And then, they won’t be able to sleep, they'll be anxious all the time, hyperactive, and so forth. And sometime, this can, this medication can cause withdrawal symptoms as well. Paranoia, panic attacks, muscle twitching and hallucination. So, those are the bad side effects of these medications.

Now, what are the contraindication for this medication? As we talked in the previous slide, that this can cause the significant respiratory depression, cardiac depression, this one has a significant sedation effect as well. So, you don’t really wanna give this medication to patient who has a sleep apnea, respiratory depression, obviously the liver disease because this medication is metabolized by liver. So, it metabolized by liver and goes into the inactive form. Now, if someone has a liver disease, this medication won’t be metabolized by liver and will not be converted into the inactive form. And what will happen? This medication will build up into up to the toxic level in the body and can cause really bad side effects like respiratory depression, they’ll stop breathing, cardiac arrest, and like those really serious side effects. And, you don’t, you want to be really teaching your patient as well, like do not take this medication and then drink. Because, if you take this medication with alcohol, they can cause like really really bad respiratory depression and sedation, and could be really lethal. Barbiturates, opioids, and any other sedative medication like Benadryl, let’s say for example, which is also used for allergic reaction. However, they can cause a really significant sedation. And many people uses Benadryl over-the-counter medication for, so they can sleep better. However, if they are in this medication, benzodiazepine, you want to tell them that do not use any over-the-counter medication without talking to your physician. ‘Cause some medication can cause really bad sedation and respiratory depression as well. So, you wanna be actually teaching your patient about that too.

Now, what is the antidote of these medications? If you have a patient and somehow the patient got high dose of this medication, and had really bad respiratory depression, what would you do? Or, cardiac arrest, or cardiac depression, like that. The antidote is Flumazenil. So, this is the antidote of this medication, this group of medication. Benzodiazepine. It will reverse the respiratory depression. So, you really wanna be careful because these medications are widely widely used in hospitals.

Now, what are the examples of this medication? All the -zepam, usually, like if you see that, Diazepam, Lorazepam, Temazepam, Oxazepam, Clonazepam, Flurazepam. This is only the different medication, the name, Chlordiazepoxide and that’s really actually old benzodiazepine medication. It’s been in the market for a while. But these are the medication, like easy to remember, anything ends with a -zepam, is benzodiazepine. And usually, these Lorazepam and Diazepam are widely used medication. They are used for seizures, often in the critical care especially if you are working in neuro ICU, you’ll see this medication a lot to control the seizures. Then, you will use this as a anti-anxiety medication. This one also for panic disorders. So, these 2 medication are widely actually used for, in a wide variety of settings, like critical care and also some people, some patient goes on this medication at home. So, you want to be really teaching about that we run into the previous slides.

Alright, that was it about the benzodiazepine. If you have any questions, just let us know or e-mail us. Thanks for watching.