Understanding Lorazepam and Its Effects

Jan 17, 2025

Lecture Notes: Lorazepam (Ativan)

Introduction

  • Presenter: Ryan from rpnt.ca
  • Topic: Lorazepam, also known as Ativan
  • Belongs to benzodiazepine drug class (benzos)

Mechanism of Action

  • Enhances the effect of gamma-aminobutyric acid (GABA)
  • GABA: Main inhibitory neurotransmitter in the central nervous system (CNS)

Neuron Function

  • Neurons transfer information via electrical signals (action potentials)
  • Neurotransmitters influence action potentials
    • Excitatory: Promote action potentials
    • Inhibitory: Inhibit action potentials (e.g., GABA)
  • GABA reduces neuron excitability, slowing information transfer

Benzodiazepines and GABA

  • Benzodiazepines enhance GABA effects
  • Resulting effects: Sedation, drowsiness, muscle relaxation, decreased anxiety

Uses of Lorazepam

  • Treatment of anxiety symptoms
  • Anxiety-associated insomnia
  • Pre-operative anesthetic
  • Status epilepticus: Severe form of seizures

Off-label Uses

  • Seizure prophylaxis
  • Alcohol withdrawal syndrome
  • Muscle spasms

Side Effects

  • Related to CNS depression
  • Common: Sedation, dizziness, weakness, unsteadiness
  • Less common: Hypotension, blurred vision, suicidal ideations, tachycardia, respiratory depression

Contraindications and Precautions

  • Contraindicated in patients with hypersensitivity to benzodiazepines
  • Avoid in narrow-angle glaucoma
  • Exercise caution in:
    • History of addiction
    • Suicidal ideations
    • Untreated depression
    • Respiratory diseases (COPD, sleep apnea)
    • Impaired renal/hepatic function
    • Elderly (doses may need adjustment)
    • Children under 12 (safety not established)

Interactions and Administration

  • Interactions with CNS depressants (opioids, alcohol) can increase sedation, respiratory depression
  • Ensure support for ambulation and daily activities when starting treatment

Overdose Treatment

  • Benzodiazepine antagonist: Flumazenil may be used
  • Flumazenil blocks/inhibits GABA receptors

Discontinuation

  • Do not abruptly stop lorazepam; gradually taper dose per provider's instructions

For further questions or help, visit rpnt.ca.