BZD toxicity by Abdelali Agouni https://padlet.com/aagouni78/ysy1e52tjqi9 Made with a warm hug en-us 2017-11-20 08:10:52 UTC 2025-11-27 08:54:09 UTC hello@padlet.com Group BZD... MA. SH. MB.AM https://padlet.com/aagouni78/ysy1e52tjqi9/wish/208609400 Q1:enhances the action of the inhibitory neurotransmitter GABA; also causes inhibition of other neuronal systems. Consequently this inhibition results in generalized depression of spinal reflexes and the reticular activating system. This can cause coma and respiratory arrest
Q2: Respiratory arrest is more likely with newer short acting agent: midazolam, triazolam, alprazolam.
Q3: CNS depression (30-120 minutes within ingestion time), lethargy, slurred speech, ataxia, coma, respiratory arrest, hypothermia.
Q4: The ratio has not been quantified exactly, but these agents generally have a very high toxic-therapeutic ratio.
Q5: In general CNS depressant increase BZDs toxicity and those may include alcohol, barbiturates, opioids.
Q6: Differential diagnosis should include other sedative-hypnotic agents, antidepressants, antipsychotics and narcotics. (E.g coma, and pupil restriction if no response to naloxone then give flumazenil).
Q7: 1. Stabilization and maintenance of open airway and ventilation. 2. Treatment of coma, seizures, hypotension, hyperkalemia, hypoglycemia. 3. Treat bradycardia with glucagon (other choices include atropine or isoproterenol) 4. Great bronchospasm with nebulized bronchodilators. 5. Continue monitoring vital signs and ECG for at least 6 hours. 
Q8:


]]> 2017-11-20 08:14:52 UTC https://padlet.com/aagouni78/ysy1e52tjqi9/wish/208609400 WD, SA, NA https://padlet.com/aagouni78/ysy1e52tjqi9/wish/208611135 Question 1 
Benzodiazepines enhance the action of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). They also inhibit other neu- ronal systems by poorly defined mechanisms. The result is generalized depres- sion of spinal reflexes and the reticular activating system. This can cause coma and respiratory arrest. 
question 2  
newer short-acting benzodiazepines such as triazolam (HalcionTM), alprazolam (XanaxTM), and midazolam (VersedTM). It has also been reported with zolpidem (AmbienTM).
Question 3
CNS depression and Lethargy, slurred speech, ataxia, coma, and respiratory arrest may occur. Generally, patients with benzodiazepine-induced coma have hyporeflexia and mid-position or small pupils. Hypothermia may occur.
Question 4  
therapeutic ratio for benzodiazepines is very high. For example, oral overdoses of diazepam have been reported in excess of 15–20 times the therapeutic dose without serious depression of consciousness. On the other hand, respiratory arrest has been reported after ingestion of 5 mg of triazolam and after rapid intravenous injection of diazepam, midazolam, and many other benzodiazepines. Also, ingestion of another drug with CNS-depres- sant properties (eg, ethanol, barbiturates, opioids, etc) will likely produce additive effects.
Question 5
ingestion of drugs with CNS-depres- sant properties (eg, ethanol, barbiturates, opioids, etc) will likely produce additive effects 
Question 6
The dif- ferential diagnosis should include other sedative-hypnotic agents, antidepres- sants, antipsychotics, and narcotics.
Question 7
  1. Protect the airway and assist ventilation if necessary.
  2. Treat coma, hypotension, and hypothermia, if they occur. Hypotension usually responds promptly to supine position and intra-venous fluids. 
Question 8
Because the overdose  by itself is rarely fatal, therefore, administration of flumazenil with routine management is not well established, and it has some drawbacks potential drawbacks: 
  1. It may induce seizures in patients with tricyclic antidepressant overdose. 
  2. It may induce acute withdrawal, including seizures and autonomic instability, in patients who are addicted to benzodiazepines. 
  3. Resedation is common when the drug wears off after 1–2 hours, and repeated dosing or a continuous infusion is often required. 
Question 10
  1. Prehospital. Administer activated charcoal if available. 
  2. Hospital. Administer activated charcoal. Gastric emptying is not necessary if activated charcoal can be given promptly. 
Question 11
There is no role for diuresis, dialysis, or hemoperfusion. Repeat-dose charcoal has not been studied. 
]]> 2017-11-20 08:21:48 UTC https://padlet.com/aagouni78/ysy1e52tjqi9/wish/208611135