Benzos for Bozos (9) Flashcards Preview

Anesthesia Pham I > Benzos for Bozos (9) > Flashcards

Flashcards in Benzos for Bozos (9) Deck (20)
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1

Three most commonly used benzos in our practice?

Midazolam (Versed), Lorazepam (Ativan), and Diazepam (Valium)

2

Order of potency of top 3 benzos?

Lorazepam > Midazolam > Diazepam

3

What determines potency of benzos?

Receptor binding affinity (all are highly lipophilic and protein-bound)

4

General chemical structure of benzos?

Benzene ring fused to 7-member diazepine ring, 2 Ns @ 1 & 4, phenyl @ 5

5

On which receptors do benzos work?

GABA receptor complex (alpha subunits); allows Cl to pass inside neuron, making cell more negative, decreasing response (inhibitory) to other neurotransmitters.

6

Do benzos produce amnesia?

Yes, yes they do. They produce anterograde amnesia.

7

What do you know about the amnesia produced by benzos?

Doesn't affect previously formed memories; does not affect short-term memory, but memories are likely are not transferred to long-term memory. Memory impairment may be more pronounced in IV administration, high dose, slow elim., and accumulation of drug.

8

Does the high protein-binding of benzos affect distribution and effect?

Yes. Hypoalbuminemia leads to increased levels of free drug in the plasma, leading to greater distribution and effect.

9

Desired effects of benzos:

Anterograde amnesia
Sedation/ hypnotic
Anxiolytic
Anticonvulsant
Skeletal muscle relaxant

10

Side effects of benzos that are not necessarily desired:

Decr. CMRO2 and CBF
Do not increase or decrease ICP
Minimal depression of ventilation

11

How do elderly folks do with benzos?

They are more sensitive.

12

Benzos have _______ effects with other drugs like opioids and propofol.

synergistic

13

What are indications for benzos?

Sedation
Anesthesia induction
Anesthesia maintenance
Anticonvulsant

14

Benzos metabolized:

In the liver (1st order kinetics):
-Midaz: CYP450 3A4 (phase I)
-Diaz: N-demthylation (phase I)
-Loraz: glucuronic acid conjugation (phase II)

15

Benzos _____ MAC of VAAs.

decrease (by 30%)

16

Diazepam: Onset/Peak/Duration

30-60 min PO/ 1-2 hrs/ 48-96 hrs

17

Lorazepam: Onset/Peak/Duration

1-2 mins (IV)/ 20-30 min/ 6-10 hr

18

Midazolam: Onset/Peak/Duration

30-60 sec (IV)/ 3-5 min/ <2 hr (15-80 min)

19

Reversal for benzos?

flumazenil (Romazicon)

20

How does that flumazenil stuff work?

Competative antagonism; watch for resedation, lasts for about 15 mins, does not reverse ETOH or barbs.