Benzodiazepines

Key points

• Benzodiazepines: enhance GABA-A receptor activity → sedation, anxiolysis, anticonvulsant, muscle relaxation.
• Long-acting: diazepam (active metabolites); short-acting: lorazepam (safe in liver disease — no phase I metabolism).
• Risks: dependence, tolerance, respiratory depression (esp. with opioids/alcohol); avoid long-term prescribing.
• Overdose: flumazenil reverses — but caution in dependent patients/epileptics (precipitates seizures).
• Lorazepam, oxazepam, temazepam ('LOT') have no active metabolites — preferred in liver disease.

Decision points in this pathway

• Liver impairment?
• Overdose with respiratory depression?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.