[Music] hi everyone this is ryan from rpnt.ca and today we're going to be talking about the drug lorazepam also known as ativan you can use the timestamps in the video description to jump ahead lorazepam belongs to the benzodiazepine drug classification sometimes just called benzos benzodiazepines work by enhancing the effect of the inhibitory neurotransmitter called gamma aminobutyric acid more commonly known as gaba now that's a lot to take in so let's break down what all of that means so in our body we have neurons that transfer information throughout the entire brain and body and the way that this information gets from neuron to neuron is through electrical signals which we call action potentials so these action potentials are extremely important for getting information across neurons we also have neurotransmitters which can influence these action potentials we have excitatory neurotransmitters and inhibitory neurotransmitters to simplify things we'll say that the yellowish red circles here are the excitatory neurotransmitters you can think of excitatory neurotransmitters as the ones that are excited the ones that are promoting or stimulating action potentials so they are exciting or encouraging whichever neurons that they're acting on and inhibitory neurotransmitters are the opposite they are kind of the downers the ones that inhibit or prevent action potentials the neurotransmitter called gaba is actually the main inhibitory neurotransmitter in the central nervous system or cns again just to simplify things let's say that gaba are these little green dots gaba reduces the excitability of neurons which slows down the transfer of information so let's review all of that we said that benzodiazepines like lorazepam work by enhancing gaba so benzos enhance the main downer of the cns resulting in sedation drowsiness muscle relaxing effects decreased anxiety and more now that we know how benzos work it's a lot easier to work through what they're used for lorazepam can be used for the treatment of anxiety symptoms anxiety-associated insomnia and pre-operatively as an anesthetic lorazepam can also be used for the treatment of status epilepticus which is a severe form of seizure seizures occur during the abnormal excitation of neurons so it makes sense that lorazepam a drug that promotes the main inhibitory neurotransmitter works against those excitable neurons some off-label uses of lorazepam include seizure prophylaxis alcohol withdrawal syndrome muscle spasms and more many of lorazepam's side effects relate to how benzos work which is essentially as a central nervous system depressant cns depression may present as sedation dizziness weakness unsteadiness and more there are many other less common side effects just some of which include hypotension possibly due to decreased anxiety blurred vision suicidal ideations tachycardia respiratory depression and more lorazepam is contraindicated in patients with hypersensitivity to benzodiazepines also avoid use in clients with narrow ankle glaucoma as lorazepam may increase intraocular pressure in rare cases precaution should be used in patients with a history of addiction and patients with suicidal ideations lorazepam should not be given to patients with untreated depression also exercise caution in patients with respiratory disease like copd or sleep apnea and in patients with impaired renal or hepatic function such as elderly patients in these patients doses will likely have to be lowered in children less than 12 years old lorazepam's safety and effectiveness have not been established always remember to assess and monitor for side effects of lorazepam be aware that there are many interactions with lorazepam which may increase or decrease its effectiveness other cns depressants like opioids and alcohol may increase the effects of sedation and respiratory depression which can be life-threatening when a patient first starts on lorazepam ensure that they have proper support to assist with ambulation and other activities of daily living this will help with drowsiness and dizziness and will help reduce the risk of falls especially in elderly patients for treatment of overdose a benzodiazepine antagonist such as flumazonil may be used more specifically flumazonil blocks or inhibits gaba receptors lastly as with many medications do not discontinue lorazepam abruptly but instead gradually taper the dose according to the provider's instructions and that's about it for the basics of lorazepam if you have any questions please let me know in the comments or visit rpnt.ca for more help