Benzodiazepines flashcards
7 high-yield MRCP Part 1 cards from the Intellect Medicos Psychiatry course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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Benzodiazepines act at the GABA-A receptor and increase the ______ of chloride channel opening.
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frequency
Why? Barbiturates instead increase the duration of opening, and at high doses open the channel directly, which makes them more dangerous in overdose.
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What is the specific antidote for benzodiazepine overdose?
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Flumazenil.
Why? It is a competitive GABA-A benzodiazepine-site antagonist. Most benzodiazepine overdoses are managed supportively.
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Name two important adverse effects of benzodiazepines in older people.
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Falls and confusion (also sedation and anterograde amnesia).
Why? Older people are more sensitive to benzodiazepines and clear them more slowly, so falls and hip fractures are a major risk.
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When withdrawing a long-term benzodiazepine, which drug is it usually switched to first?
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Diazepam, at an equivalent dose, then tapered gradually.
Why? Its long half-life gives smoother blood levels and fewer withdrawal symptoms between doses.
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How fast does the BNF suggest reducing diazepam when withdrawing a long-term benzodiazepine user?
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Usually by 1–2 mg every 2–4 weeks, adjusted to symptoms. Full withdrawal can take several months to a year or more.
Why? Abrupt withdrawal can cause confusion, psychosis, seizures or a state like delirium tremens.
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Name three features of benzodiazepine withdrawal syndrome.
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Any three of: insomnia, anxiety, tremor, sweating, tinnitus, perceptual disturbance, loss of appetite and weight. Severe: seizures, confusion, psychosis.
Why? It can start within a day of stopping a short-acting drug, or up to 3 weeks after a long-acting one.
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Which co-prescribed drug class carries an MHRA warning about fatal respiratory depression with benzodiazepines?
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Opioids.
Why? Both depress breathing and sedation is additive. Prescribe together only if there is no alternative, at the lowest doses and for the shortest time.