Benzodiazepines lorazepam

The benzodiazepine, lorazepam, acts allosterically on GABAa receptors to facilitate the actions of GABA. Lorazepam has some antiemetic activity in cancer chemotherapy. When used in combination therapy, it does not appear to add to antiemetic control but may contribute to a reduction in anxiety. 

There is, however, a unique risk in the bipolar form that antidepressant treatment may trigger a switch into mania. This may occur either as the natural outcome of recovery from depression or as a pharmacological effect of the drug. Particular antidepressants (the selective serotonin reuptake inhibitors) seem less liable to induce the switch into mania than other antidepressants or electroconvulsive therapy. Treatment for mania consists initially of antipsychotic medication, for instance the widely used haloperidol, often combined with other less specific sedative medication such as the benzodiazepines (lorazepam intramuscularly or diazepam orally). The manic state will usually begin to subside within hours and this improvement develops further over the next 2 weeks. If the patient remains disturbed with manic symptoms, additional treatment with a mood stabilizer may help. 

Second, if response is inadequate, consider adding a benzodiazepine (lorazepam or clonazepam) for short-term adjunctive treatment of agitation or insomnia if needed Third, if response is inadequate, consider a two-drug combination ... 

It does bear special mention that many mental health practitioners consider lorazepam (Ativan) to be the most versatile of the benzodiazepines. Lorazepam has an intermediate onset and duration of action. Because it is easily metabolized, lorazepam is preferred when a benzodiazepine must be used to treat medically compromised or elderly patients. Most importantly, lorazepam is the only benzodiazepine that can be administered via oral, intramuscular, and intravenous routes. As a result, the transition between inpatient and outpatient care is rendered much easier with lorazepam than other benzodiazepines. 

Treatment begins with standard emergency procedures such as maintaining an airway, starting an IV line for blood sampling and drug administration, and so on.28 The first drugs administered are usually benzodiazepines lorazepam (Ativan) or diazepam (Valium)... 

GABAA-R-mediated sIPSCs were examined and we found that the marked increase of decay time constant, amplitude, and area caused by this neurosteroid was not different between rats at PI9 and those in estrus. Similarly, the potentiation of sIPSCs recorded in dentate gyrus granule cells induced by the benzodiazepine lorazepam (3 /lM), although slightly reduced in rats at PI9 compared to control, resulted not different among these animals. 

Although diazepam (see p. 89) is the prototype benzodiazepine, lorazepam and midazolam are more potent. All three facilitate amnesia while causing sedation. Etomidate [e TOE mi date] is a hypnotic substance lacking analgesic properties that can cause uncontrolled skeletal muscle activity. 

The safety of benzodiazepines in neonates has been assessed in a retrospective chart review of 63 infants who received benzodiazepines (lorazepam and/or midazolam) as sedatives or anticonvulsants (57). Five infants had hypotension and three had respiratory depression. In all cases of respiratory depression, ventilatory support was initiated or increased. Significant hypotension was treated with positive inotropic drugs in two cases. Thus, respiratory depression and hypotension are relatively common when benzodiazepines are prescribed in these patients. However, both depression and hypotension could also have been due to the severe underlying illnesses and concomitant medications. Matched controls were not studied. 

Reinforcing, subjective, and performance effects have been compared between oral diphenhydramine and the benzodiazepine lorazepam in men with a history of recreational abuse, and the results suggested that the two drugs have similar abuse potential (SEDA-21, 174). 

E Respiratory depression is seen with benzodiazepines (lorazepam, diazepam) and with barbiturates (phenobarbital, pentobarbital). Both classes are associated with sedation, somnolence, and respiratory depression. However, both phenytoin and fos-phenytoin do not affect respiratory rate. 

A combination of paracetamol (acetaminophen) plus codeine is especially well suited to post-peel pain, but should not be used in the hours following a phenol peel, as paracetamol (a phenol derivative) goes through the same detoxification pathways as phenol, which could create metabolic competition and the risks of toxicity associated with phenol might be increased. Preventive administration of benzodiazepines (lorazepam 2.5 mg before the peel and on the night of the peel before going to bed) relieves the anxiety caused by these unpleasant sensations and reduces the need for analgesics after the peel. In case of very severe, localized pain (extremely rare), a nerve block could be used. 

Valproate monitor for hypertension, tachycardia, peripheral edema Benzodiazepines (lorazepam) for acute treatment... 

After first trimester carbamazepine, lamotrigine, oxcarbazepine, or valproate Second choice benzodiazepine (lorazepam) Third choice calcium channel blocker With psychosis first choice adjunctive high-potency typical antipsychotic (haloperidol, perphenazine, thiothixene, or trifluoperazine)... 

Chlorpromazine Flaloperidol Thioridazine Atypical Antipsychotics Clozapine Risperidone Benzodiazepines Lorazepam Oxazepam Triazolam... 

As with most benzodiazepines, lorazepam is highly bound to plasma proteins (over 85 percent). The serum half-life of lorazepam is approximately 12 to 15 hours. The drug undergoes hepatic metabolism and is rapidly conjugated to an inactive glucuronide. Excretion of the metabolite is primarily renal, with a small percentage excreted through the bile. 

In contrast to other benzodiazepines, lorazepam does not appear to depress respiration when assessed by methods including the ventilatory response to carbon dioxide. 

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