Lecture Notes: Benzodiazepines

Introduction

• Speaker: Sarah from registerednessrn.com
• Topic: Benzodiazepines (Benzos or BZDs)
• Function: Calm the central nervous system (CNS depressants)
• Effects: Anxiolytic, sedative, hypnotic
• Free quiz available after watching video

Recognizing Benzodiazepines

• Look for "z" in the generic name (e.g., -zep-
• Common endings: -lam or -pam (except chlorazepate and chlordiazepoxide)
• Popular examples:
  • Alprazolam
  • Lorazepam
  • Clonazepam
  • Tenazepam
  • Diazepam
  • Midazolam

Uses of Benzodiazepines

• Treat conditions with excessive CNS stimulation:
  • Anxiety
  • Seizures
  • Panic attacks
  • Alcohol withdrawal
  • Insomnia
  • Pre-procedure calming (e.g., midazolam for trans-esophageal echo)
• Administration: IV, PO, IM, rectal

Mechanism of Action

• Neurotransmitter: GABA (Gamma-Aminobutyric Acid)
• Role of GABA:
  • Inhibitory neurotransmitter
  • Reduces neuron firing, leads to calming effects
• Benzos enhance GABA effects
• Receptor focus: GABA A receptors (ligand-gated, ionotropic)
• Process:
  • Benzos and GABA bind to GABA A receptors
  • Opens chloride channels, causing hyperpolarization
  • Inhibits action potential, leading to calming effect

Understanding Neurotransmitters

• Neurotransmitters: Chemical agents from neurons
• Types:
  • Excitatory: Increase action potential (neuron firing)
  • Inhibitory: Decrease action potential

GABA A Receptor Structure

• Five subunits: 2 alpha, 2 beta, 1 gamma
• Binding Sites:
  • GABA binds between alpha and beta
  • Benzos bind between alpha and gamma
• Result: Chloride ions enter cell, causing hyperpolarization

Nursing Responsibilities

• B for Beers list: Caution in older adults
  • Increased risk of toxicity, dependence, and falls
• E for Avoid alcohol, opioids, other CNS depressants
  • Risk of overdose and death
  • FDA black box warning
• N for Not recommended for long-term use
  • Risk of dependence and withdrawal
• Z for Sleepy effect
  • Avoid activities needing focus/coordination
• O for Overdose reversal: Flumazenil
  • Antidote for benzo toxicity

Signs of Benzodiazepine Toxicity

• Mnemonic: ABUSED
  • A: Altered mental status (drowsy, coma)
  • B: Bradycardia (slow heart rate)
  • U: Unable to walk (ataxia)
  • S: Speech (slurred, garbled)
  • E: Experienced hallucinations/memory loss
  • D: Decreased respiration

Quiz Question

• Amplifies which neurotransmitter?
  • Correct Answer: GABA (Gamma-Aminobutyric Acid)