questions 5

Benzodiazepines

Topic updated on 06/07/17 6:29pm

Snapshot
  • A 56-year-old man is brought to the emergency department after being found in the park in a lethargic state. The patient has a history of multiple hospital visits for pain management of acute pancreatitis. Medical history is significant for alcohol use disorder. On physical exam, the patient has slurred speech, nystagmus, and unsteady gait. Laboratory testing is significant for an elevated blood alcohol level. Urine and serum toxicology is negative for illicit drugs. He is started on intravenous thiamine and glucose. Approximately 6 hours after admission the patient becomes nauseous, anxious, tremulous, and develops palpitations. He is subsequently started on intravenous lorazepam. (Alcohol withdrawal)
Introduction
  • Medications
    • short-acting benzodiazepines
      • alprazolam
      • triazolam
      • oxazepam
      • midazolam
    • longer-acting benzodiazepines
      • flurazepam
      • chlordiazepoxide
      • lorazepam
      • diazepam
  • Mechanism of action
    • ↑ the frequency of Cl- channel opening and thus facilitating GABAA action
      • via its binding to the α and γ subunit of the GABAA receptor
        • this in turn ↓ neuron firing
  • Metabolism
    • oxazepam, temazepam, and lorazepam
      • is not dependent on liver metabolism
  • Adverse reaction
    • dependence
    • can have an additive CNS depressive effect with other CNS depressants (e.g., alcohol and barbiturates)
    • the antidote to benzodiazepine overdose is
      • flumazenil
        • a competitive benzodiazepine receptor antagonist
  • Clinical use
    • anxiety and panic disorder
    • status epilepticus
    • alcohol withdrawal
    • anesthesia premedication
    • sleep walking and other parasomnias
    • skeletal muscle relaxation
    • insomnia
 


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(M1.NE.1) A 15-year-old male sustained a laceration to his left lower extremity (Figure A) during a football game and was stitched up by the EMT later that day. Six days later, the teenager began to experience neck rigidity, laryngospasms, dysphagia, and risus sardonicus. He was taken to the hospital where he was given treatment for an infection caused by a gram-positive, anaerobic bacili that consisted of metronidazole, immunoglobulins targeting the toxoin, and a long-acting medication that facilitates the GABA-A receptor by increasing the frequency of the chloride channel opening. Which of the following medications was he given? Topic Review Topic
FIGURES: A          

1. Triazolam
2. Diazepam
3. Oxazepam
4. Flumazenil
5. Midazolam

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