What Are Benzodiazepines?
Benzodiazepines are a very widely used medication for a few different reasons.
The whole idea of benzodiazepines is that benzodiazepines affect the GABA receptors. The GABA receptors are the main inhibitory neuron or neurotransmitter within the central nervous system.
When it produces a response, benzodiazepine attaches and produces respond from the GABA receptors, it causes a decrease in the level of consciousness.
Essentially, the whole point of having benzodiazepine is that what it does within the GABA receptor, what it does in the central nervous system, is that it slows down transmission of signals. By doing that it basically has an influx of chloride, it's hyperpolarizing the cell. And by hyperpolarizing the cell it's much more difficult for a neuron to fire.
That means we're going to have less central nervous system transmission. That's why it's good for using it for seizures, aggressive patients, anxiety those kinds of things because those are all due to severe neuron activity within the central nervous system that's producing an effect in the body.
What benzodiazepines are great for is that they reduce the amount of electric activity in the central nervous system. To the point where you're going to see a decreasing level of consciousness and if you use enough of it a full complete unconsciousness with a severe respiratory depression.
That's another side of it. Be realistic when you use this type of drugs because of its pretty hard-hitting effects.
Benzos reduce anxiety, have a sedative effect, integrate amnesia. They also possess convulsing and muscle relaxant effects.
The big thing with this is to make sure you're monitoring the SPO2, which is very important because spo2 is going to be affected just because we have a severe respiratory depression and a decrease in central nervous system reactivity.
We might see some D SATs on these patients. That is why it's important to put an SPO to monitor on them. And if they D set to the point where you need to put an auction on them. That's important to identify in someone that's using benzodiazepines.
Everyone effect is affected differently with benzos. Typically, I go on the low-end mostly because of experiences with not overdosing but definitely having pretty major effects by giving someone a little too much.
It's a normal thing in a protocol to give anywhere with 2.5 to 5 milligrams.
And a couple patients that I've had I've seen some pretty major respiration depression to decrease in central nervous system reactivity with using just those types of doses.
Typically, I use anywhere between 1mg and work my way up to the point where now I have the achieved effect.
It's the better way to do it. This way you can monitor and control your patient much better depending on the effect you're looking for.
There is a way to reverse the effect, as well. We don't carry it typically on an ambulance, but flumazenil is the medication of choice for reversing benzodiazepines.
Types Of Benzodiazepines
Benzodiazepines increase the frequency of GABA firing. They bind to the GABA a receptor as well as alcohol and barbiturates and increases the frequency of the chloride channel opening.
It also does some interesting things. You use it to treat sleep and seizure disorders sleep. Sleep disorders like insomnia and seizure disorders as like increased movement or some sort of mass effect in the brain.
What happens if you have these overactive disorders. An overactivity is caused by a stimulation of different things in the brain. GABA is a chloride channel which decreases the rate of firing of these things. If you increase the frequency of the chloride channel opening, then you have a decreased activity. You use this to treat overactive disorders.
Short Acting Benzodiazepines
The short-acting benzodiazepines are triazolam, oxazepam, alprazolam and midazolam. These the short-acting ones, which means their effect wears off in 10 hours.
There is an also another T- benzodiazepine like triazolam. TOAM is the short acting ones.
You have an increase in efficiency over a short period of time. However, that increases the rate of addictiveness. Because you have that burst of inhibitory effect, then you go into withdrawal quicker, which leads more substance abuse potential.
Medium Acting Benzodiazepines
The next is the medium acting group of benzos like lorazepam, estazolam and temazepam.
The LET is a short for the medium acting benzodiazepines. But the T is different - temazepam is in the media group and triazolam is in the short-acting group.
They have a medium range of time and which is effective. They also have a medium amount of substance abuse potential. This group is between the short-acting and along with acting benzos
The next group is the long-acting benzodiazepines. And here we have CCPF, unique letters compared to the short and medium acting ones. And you also have the two ones that have the weirdest names.
In this group we have chlordiazepoxide, clorazepate, diazepam and flurazepam. The interesting about this is that they have an effect up to 4 days.
The thing is they have a low potential for abuse because they have such low stimulation over a long period of time.
The other thing about this is that they cause so much daytime drowsiness, ataxia. It is a long inhibitor of all your actions. Unlike short-acting drugs, which inhibit your actions for a short period of time, these inhibit your actions for a long period of time.
If you take benzos for sleep, you have lowered REM cycle. When compared to barbiturates, you have a lower risk of respiratory depression and coma.
The last things you need to know is that you have to use flumazenil to treat the overdose with benzodiazepines.