hey everyone it's sarah with registerednessrn.com and in this video i'm going to talk about benzodiazepines and as always whenever you get done watching this youtube video you can access the free quiz that will test you on this material so let's get started benzodiazepines also known as benzos or bzds are a group or class of drugs that actually calm the central nervous system therefore they're known as cns depressants now these drugs can have an anxiolytic sedative or hypnotic effect on the body and whenever we talk about the mechanism of action how these drugs actually work on the body like with the receptors and the specific neurotransmitter it affects you're going to see how these drugs actually cause these effects to occur in our body now whenever you're studying these drugs you're going to see that there's various types of benzos available for use some are very potent some are short acting some are long acting and it really depends on what's going on with the patient to determine what type of benzo should be used now how do you recognize a benzodiazepine say you're looking at a patient's list how do you know if this is a benzo or not well there's two things you can look for and you're looking at that generic drug name the first thing is look at the middle of that name and look for a z e or a z o in benzodiazepine we have a z present in the name that usually tips you off that this is a benzo another thing that you can look at is that most end in lamb or pam except for two and this includes chlorazepate and chlorodiazepoxide now some popular ones that you will see in practice that do follow those two rules are alprazolam lorazepam clonazepam tenazepam diazepam and midazolam so now let's talk about what benzos are used for what conditions are they really good at treating well we've established that benzos are cns depressants so they're really good at treating conditions where there is too much cns stimulation where these neurons are just rapidly firing we have too much activity going on up there so we need to calm things down and they're great at treating patients who experience anxiety seizures panic attacks or whenever they're withdrawing from alcohol or they're having trouble sleeping like insomnia they can also be used before a procedure and many times i have given a patient before a tea a trans-esophageal echo or a cardioversion versed that is midazolam and this helps calm that patient down it also helps them not really remember the procedure and so they're really helpful for that and these medications can be given various ways you can give them iv you can give them po i am intramuscular rectally etc now let's talk about the mechanism of action and how benzos work to actually depress the central nervous system and to provide that calming tranquilizing effect on the body in order to achieve this it all deals with a neurotransmitter specifically known as gaba and gaba stands for gamma-aminobutyric acid so whenever a benzo is on board in a patient's body what it's going to do is it's going to amplify the effects that gaba already normally has on that central nervous system so it's going to exaggerate the effects that we need in order to treat whatever conditions going on with our patient now gaba is considered an inhibitory neurotransmitter now what does that mean well first let's talk about neurotransmitter a neurotransmitter is a chemical agent that is produced and released by a neuron hence why we call it a neurotransmitter and it transmits messages to a specific structure that it was actually designed to communicate to this could be a gland or many times it's a neuron so it's going to send these specific messages and these neurotransmitters i like to think of them as like little raindrops that are raining down and they're going to go to where they need to go on let's say that neuron because that neuron that it's communicating with is going to have these special receptors they're just going to set there and accept that specific neurotransmitter so this neurotransmitter can either have an excitatory effect on that specific structure it was designed to target like that neuron or an inhibitory effect now sometimes neurotransmitters can have both effects but it really depends on where they're acting in the body but gaba is one of the main inhibitory neurotransmitters so let's talk about the difference between an excitatory inhibitory real quickly so an excitatory tran neurotransmitter what it's going to do is it's going to excite and it's going to increase the potential of an action occurring like the neuron firing and sending that message so it's going to make sure that message is sent an inhibitory neurotransmitter just as it name its name says it's going to inhibit so it's going to decrease the potential of an action occurring so it's not going to really allow it and it's going to inhibit that message from being sent so that's where gaba gets its qualities because it's going to inhibit decrease that firing of that neuron so that patient can chill have that calming tranquilizing effect on the body now to help us really understand and see how these neurotransmitters actually are released from the neuron onto a receptor site let's look at this animation so here you can see that this neuron is releasing a neurotransmitter the neurotransmitter is in yellow and it's raining down and for that neurotransmitter to be successful to send whatever message it needs to send to the other neuron whether it's an exciting or inhibiting message it must bind onto its special receptor which will help complete that action now when the neurotransmitter gaba is released from its neuron it's going to go and bind with gaba receptors and many gaba receptors are found in our limbic system and this is a system that helps us process our emotions and really dictates the way that we behave so there are two types of gaba receptors there's gaba a receptors and gaba b receptors benzos are going to specifically affect gaba a receptors so that is what you want to remember gaba a that's what we care about for this lecture so gaba a are really interesting because they are considered ligand-gated or ionotropic receptors and these terms just really describe how they work and how they operate whenever they are being affected by let's say benzodiazepines so whenever binding occurs so we have benzo binding to the receptor along with the neurotransmitter gaba neurotransmitter which you're going to see here in a second it's going to cause a channel to open whenever that channel opens ions are going to move in to the cell and whenever this occurs it's going to cause hyperpolarization and this is going to cause that inhibitory action where it's going to inhibit potential action from occurring hence we're going to get calming tranquilizing effects and we're specifically talking about the ion chloride so now let's take a closer look at these gaba a receptors and look at their unique design and how they work to actually cause this effect so hopefully it'll seal this concept in your mind okay so the gaba a receptor has these divisions and it's divided into five subunits you have two alpha subunits two beta subunits and one gamma subunit and on these subunits we have a total of three binding sites there are two sites that are for the neurotransmitter gaba and gaba will go here and bind with this receptor in between both of the alpha and beta subunits then we have a binding site specifically for the benzodiazepine chemical and it's going to bind here in between alpha and gamma so it has its own little special site and in between all of these subunits right there in the middle is like this little opening this pore and this is what will open and allow our ion to move down into the cell and cause hyper polarization so we have gaba neurotransmitter raining down from our neuron here and it goes and it sits at this binding site and it locks down on it so there's our gaba then the patient has taken a benzo so that chemical is there in the body it's going to be here and it's going to bind to its site and whenever this occurs what's going to happen is that this channel down here is going to open up and once it opens up these chloride ions which are negatively charged are going to go down into the cell what this does is it causes hyperpolarization it's going to make it negative and this is going to decrease firing potential so decrease that action potential and it's going to hence cause a calming tranquilizing effect so we're going to have an amplified effect of how gaba would normally work on that central nervous system so this is great for a patient who is having anxiety panic attacks or having those withdrawal symptoms from alcohol will help depress that central nervous system now let's wrap up this lecture and let's talk about the nursing responsibilities side effects and patient education pieces that you want to provide to the patient who is taking these type of medications and to help us remember all those important concepts we're going to remember the word benzo so b is for beers list what is this well this is a list that the american geriatrics society created of drugs that older adults shouldn't really be taking because it can cause harmful side effects to them and benzodiazepines is on that list and whenever an older adult is taking a benzo it increases the risk majorly of toxicity dependence on the drug abuse of the drug and injuries such as falls so as a nurse if you do have an older patient that is taking one of these medications you want to keep this in the back of your mind you want to educate the patient or the patient maybe they have a caregiver about this and watch out for injuries especially getting up moving they need to call for assistance because they can fall and really hurt themselves and if you would like to see all the medications that is actually on this beers list i have posted a link in the youtube description and you can access that list so it can help you in practice as well then we have e for alcohol opioids and cns depressants other cns suppressants that should be avoided while taking a benzo so you definitely want to educate the patient if they are going to be taking a benzo that these other substances do not mix with benzos because they actually increase the risk of overdose and death and the fda has actually issued a black box warning on benzos and has educated and told people do not take this drug with these other substances because that can happen and then we have in for not recommended for long-term use benzos are really best for short-term use because whenever they're used long-term there's an increased risk of the patient becoming dependent on them abusing them and having withdrawal signs and symptoms so if they are taking these long term they just can't quit cold turkey and stop them abruptly they have to be tapered off them over a period of time next is zzz for sleepy hypnotic sedative effect so when a patient takes a benzo that is what it's going to do it's going to calm them make them drowsy and you want to educate the patient whenever they do plan on taking a benzodiazepine that they want to avoid any activities that require focus or coordination because they could really injure themselves or someone around them and the last part of our pneumonic is o overdose reversal with flamazanil so flamazanil is the antidote for benzos and this drug should be used with caution whenever reversing toxicity with benzo so typically it's used whenever you know it's going to benefit the patient a lot more than the risks that are involved so as a nurse you want to be familiar with the signs of toxicity of a benzo so we know that older adults who are taking benzos are definitely at risk for toxicity and patients who are dependent on the drug because abuse may occur so whenever that happens a patient who does become dependent on a benzo in order for them to get the same effects those calming tranquil effects from the drug they have to keep taking more they have to have higher dosages so that can lead to a possible overdose or toxicity and to help you remember those signs of toxicity you can remember the word abused so a stands for altered mental status so the patient may appear very drowsy or even in a coma they can also be agitated or extremely confused then b is for bradycardia so slow heart rate u is for unable to walk or coordinate movements they can have ataxia s is for speech garbled or slurred it'll be really hard to understand them when they speak e is for experienced hallucinations or memory loss and then d is for decreased respirations okay now let's test your knowledge over the material i just covered by taking this quiz question so this question says benzodiazepines amplify the effect of what neurotransmitter our options are a serotonin b gamma aminoburteric acid c acetylcholine d epinephrine and the answer is b because remember benzodiazepines amplify that neurotransmitter gaba because what it's going to do after all this binding occurs it's going to hyperpolarize and we're going to get a decrease in firing potential which hence is going to cause some calming tranquilizing effects to the patient so that wraps up this review over benzodiazepines and if you would like more free quiz questions or more reviews over farm you can access the link in the youtube description and thank you so much for watching