Benzodiazepines are first line drugs for the treatment of acute status epilepticus, as they are fast-acting, strong and potent anticonvulsant drugs.
Midazolam is an intravenously administered benzodiazepine used to help induce anesthesia. While this drug has no anesthetic properties, it is helpful because it allows patients to relax and causes anterograde amnesia.
Many times, benzodiazepine drugs are used as acute anxiolytics. These drugs have rapid onset and provide moderate relief, but are not used long term due to the risk of dependence.
Benzodiazepines are used to treat women suffering from eclampsia, as a second-line medication if magnesium sulfate (MgSO4) is ineffective or contraindicated. Eclampsia is a life-threatening complication of pregnancy characterized by hypertension, proteinuria and tonic-clonic seizures.
These medications are useful in treating patients who are undergoing alcohol detoxification, in order to prevent withdrawal symptoms. Patients undergoing alcohol withdrawal are at risk for delirium tremens and seizures, which can be treated by benzodiazepines such as diazepam and chlordiazepoxide.
Benzodiazepines are recognizable because of the '-zepam' and '-zolam' suffix in most drug names. Common benzodiazepine drugs are diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam. Chlordiazepoxide is a benzodiazepine which does not have this trait in its name.
These drugs act by binding to a specific site on the GABAA Cl- receptor complex. This leads to Cl- channel opening with increased frequency, yielding a higher chloride conductance. This causes neuronal membrane hyperpolarization and decreased CNS excitation.
Benzodiazepines decrease REM sleep, and many patients complain of less restful sleep. Though patients sleep longer while on benzodiazepines, the amount of REM sleep decreases overall and causes increased latency to REM sleep.
Patients taking these medications can have symptoms of CNS depression. Furthermore, when combined with alcohol, profound CNS depression can occur with these drugs. Alcohol binds to GABAA, as do benzodiazepines, explaining these additive effects.
Patients may exhibit dependence when using benzodiazepines. This may manifest as inability to cope without the drug, tolerance to its effects, or withdrawal symptoms when not taking it.
Flumazenil is the antidote for benzodiazepine overdose. It acts as a competitive inhibitor to benzodiazepines on the BZD site of the GABA receptor.
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