Depression flumazenil

Midazolam and diazepam decrease arterial pressure without a change ia heart rate. Like thiopeatoae, midazolam is a respiratory depressant. Advantages of midazolam are its amnestic effect, coupled with less postoperative depression (102). A reversal agent for the benzodiazepiaes has also become available. Flumazenil [78755-81-4] C25H24FN2O2, (5) displaces the beazodiazepiaes from their receptor but has Httie demoastrable activity of its owa (103,104). 

Although rare, benzodiazepine toxicity may occur from an overdose of the drug. Benzodiazepine toxicity causes sedation, respiratory depression, and coma. Flumazenil (Romazicon) is an antidote (antagonist) for benzodiazepine toxicity and acts to reverse die sedation, respiratory depression, and coma within 6 to 10 minutes after intravenous administration. The dosage is individualized based on the patient s response, widi most patients responding to doses of 0.6 to 1 mg. However, die drug s action is short, and additional doses may be needed. Adverse reactions of flumazenil include agitation, confusion, seizures, and in some cases, symptoms of benzodiazepine withdrawal. Adverse reactions of flumazenil related to the symptoms of benzodiazepine withdrawal are relieved by die administration of die benzodiazepine. 

Q83 Flumazenil is a specific agonist used in anaesthesia to reverse the CNS depressant effects. Flumazenil should not be administered quickly to avoid too-rapid wakening, which could result in agitation, anxiety and fear. 

Hypoventilation Monitor patients who have received flumazenil for the reversal of benzodiazepine effects (after conscious sedation or general anesthesia) for resedation, respiratory depression or other residual benzodiazepine effects for an appropriate period (120 minutes or less) based on the dose and duration of effect of the benzodiazepine employed, because flumazenil has not been established as an effective treatment for hypoventilation due to benzodiazepine administration. Flumazenil may not fully reverse postoperative airway problems or ventilatory insufficiency induced by benzodiazepines. In addition, even if flumazenil is initially effective, such problems may recur because the effects of flumazenil wear off before the effects of many benzodiazepines. 

Monitoring Monitor patients for resedation, respiratory depression, or other persistent or recurrent agonist effects for an adequate period of time after administration of flumazenil. 

Respiratory disease Appropriate ventilatory support is the primary treatment of patients with serious lung disease who experience serious respiratory depression due to benzodiazepines rather than the administration of flumazenil. 

EMS Monitor for i HR resp OD Drowsiness, confusion, coma, labored breathing, hypotension, bradycardia, slurred speech, impaired coordination support BP and resp until drug wears off (1/2-life about 12 h) flumazenil may be used to reverse resp depression... 

Quazepam (Doral) [C IV] [Sedative/Hypnotic/ Benzodiazepine] Uses Insomnia Action Benzodiazepine Dose 7.5-15 mg PO hs PRN i in elderly hqjatic failure Caution [X, /-] NA glaucoma Contra PRG, sleep apnea Disp Tabs SE Sedation, hangovCT, somnolence, resp depression Interactions T Effects W/ azole antifungals, cimetidine, digoxin, disulfiram, INH, levodopa, macrolides, neuroleptics, phenytoin, quinolones, SSRIs, verapamil, grapefruit juice, EtOH effects W/carbamazepine, rifampin, rifabutin, tobacco EMS Use caution w/ other benzodiazepines, antihistamines, opioids and verapamil, can T CNS depression concurrent EtOH and grapefruit juice use T CNS depression OD May cause profound CNS depression, confusion, bradycardia, hypotension, and altered reflexes flumazenil can be used as antidote activated charcoal may be effective... 

The intramuscular dosage of diazepam solution for injection is 5-10 mg, repeated if necessary after 4 hours. A rectal solution also exists. If respiratory depression occurs, it can be reversed with the antagonist flumazenil. 

Flumazenil Romazicon) is a benzodiazepine antagonist that specifically reverses the respiratory depression and hypnosis produced by the benzodiazepine receptor agonists. Its block of the amnesic effect of the agonists is less reliable. Flumazenil is particularly useful when an overdose of benzodiazepines has occurred. It is also employed when a benzodiazepine has been used to produce conscious sedation and rapid recovery of psychomotor competency is desirable. To avoid resedation, flumazenil may require administration by intravenous infusion. 

Monitor for seizures, sedation, respiratory depression, or other residual benzodiazepine effects for an appropriate period (up to 120 min) based on dose and duration of effect of the benzodiazepine employed pharmacokinetics of benzodiazepines are not altered in the presence of flumazenil... 

Monitor and maintain a patent airway and prepare to assist with ventilation if flumazenil does not fully reverse the respiratory depressant effects of the benzodiazepine... 

Both zolpidem and zaleplon appear to be nonfatal in overdose. However, overdoses in combination with other central nervous system (CNS) depressant agents pose a greater risk. Recommended treatment consists of general symptomatic and supportive measures, including gastric lavage. Use of flumazenil may be helpful. 

Combined use of any of the drugs in this category increases the risk of death. While a single drug may not depress respiration markedly, a combination of drugs can do so. The antidote for benzodiazepine overdose is an intravenous injection of Romazi-con (flumazenil). 

Drugs that stimulate respiration (analeptics) have a place in anaesthetic practice but are not a substitute for mechanical ventilation. They have a direct effect on respiratory drive they do not share a common molecular structure. Respiratory stimulation is generally better achieved by antagonising the depressant effects of the depressant drug, e.g. flumazenil for benzodiazepines naloxone for opioids. 

Benzodiazepines—including diazepam, lorazepam, and midazolam—are used intravenously in anesthesia (see Chapter 25), often in combination with other agents. Not surprisingly, benzodiazepines given in large doses as adjuncts to general anesthetics may contribute to a persistent postanesthetic respiratory depression. This is probably related to their relatively long half-lives and the formation of active metabolites. However, such depressant actions of the benzodiazepines are usually reversible with flumazenil. 

The benzodiazepine antagonist flumazenil can be used to accelerate recovery when excessive doses of intravenous benzodiazepines are administered (especially in elderly patients). However, reversal of benzodiazepine-induced respiratory depression is less predictable. The short duration of action (< 90 minutes) of flumazenil may necessitate multiple doses to prevent recurrence of the CNS depressant effects of the longer-acting benzodiazepines (eg, lorazepam, diazepam). 

Short-term management of insomnia Action Benzodiazepine Dose 1-2 mg PO qhs PRN X in hepatic impair/elderly/debilitated Caution [X, -] T Effects w/ CNS depressants Contra PRG Disp Tabs SE Somnolence, weakness, palpitations, anaphylaxis, angioedema, amnesia Interactions T Effects W/ amoxicillin, clarithromycin T effects OF diazepam, phenytoin, warfarin X effects W/ food X effects OF azole antifungals, digoxin EMS Use caution w/ other benzodiazepines, may need a reduced dose concurrent EtOH and caffeine use can T CNS effects OD May cause altered reflexes, drowsiness, CNS depression, slurred speech, and Szs flumazenil can be used as an antidote... 

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