Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Benzo Chart
Benzo Comparison Chart
| Category | Midazolam | Lorazepam | Diazepam | Flumazenil |
|---|---|---|---|---|
| Blank | Midazolam | Lorazepam | Diazepam | Flumazenil |
| Trade Name | Versed | Ativan | Valium | Romazicon |
| Class | BZDP: imidazole ring | BZDP | BZDP | BZDP receptor antagonist |
| IV Sedation Dose Adult | 0.05 mg/kg | 0.04 mg/kg | 0.1 mg/kg IV 0.2 mg/kg po; 15 mg max | 0.2 mg IV; repeat 0.1 mg q min up to 1 mg/hr and 3mg max |
| Potency | moderate Valium x5 | MOST Versed x5/Valium x25 | least | (blank) |
| Available Conc. | 1 mg/ml & 5 mg/ml | 2 mg/ml & 4 mg/ml | 5 mg/ml | 0.1 mg/ml |
| Acid or Base | Base | Base | Base | Base |
| pKa (ionization) | 6.15 (@7.4, > non-ionized) | 11 (@7.4 >> ionized) | 3.3 (@7.4, >> non-ionized) | (blank) |
| Solubility | H2O @ pH <4 (open) Lipid @ pH >4 (closed) | Lipid | LIPID (very) | H2O in vial; Lipid @ physiologic pH |
| Protein Binding | 94% | 98% | 90% competes w/ heparin at binding site | 50% |
| Sedative/ Hypnotic? | Sedative/Hyponotic Anxiolytic | Sedative/Hyponotic Anxiolytic | Sedative/Hyponotic Anxiolytic | REVERSES |
| Analgesia? | NO | NO | NO | NO |
| Amnesia? | YES | YES (most potent) | YES | ?Reverses? (unreliable) |
| Effect Site Equilibration (Onset) | 30-90 sec (also 1-6 min some sources) | 60-120 sec | 45-90 sec | 2 min |
| Duration | 10-30 min | 1-2 hrs; amnesia up to 6 hrs | 15-30 min | 30-60 min |
| Action at Receptor | Agonist @ GABA-Cl- influx, hyperpolarize; 2x affinity of valium | Agonist @ GABA-Cl- influx, hyperpolarize; HIGH RECEPTOR AFFINITY | Agonist @ GABA-Cl- influx, hyperpolarize | Specific BZDP Competitive Antagonist Weak Agonist, <1% VERY HIGH RECEPTOR AFFINITY |
| Saturation | Receptors saturable (ceiling effect):20%- anxiolysis, 30-50%-sedation, >60% hypnosis | Receptors saturable (ceiling effect):20%- anxiolysis, 30-50%-sedation, >60% hypnosis | Receptors saturable (ceiling effect):20%- anxiolysis, 30-50%-sedation, >60% hypnosis | (blank) |
| Ligand or 2nd msgr? | Ligand | Ligand | Ligand | Ligand |
| CNS effects | Dec CMRO2, CBF; No inc ICP but no ischemic protection; CO2-vasodilation response intact; elderly more sens. to cereb. depression | Dec CMRO2, CBF; No inc ICP but no ischemic protection; CO2-vasodilation response intact; elderly more sens. to cereb. depression | Dec CMRO2, CBF; No inc ICP but no ischemic protection; CO2-vasodilation response intact; elderly more sens. to cereb. depression | Increase in ICP secondary to less sedation, not from drug itself |
| SC-mediated skeletal muscle relaxation | Yes | Yes | Yes | (blank) |
| Burst Suppressive | NO | NO | NO | NO |
| Sz | ALL ARE ANTICONVULSANTS (slower/less potent [but more specific] than barbs): membrane stabilization (use in inadvertent IV local anesthetic); also Sz preventative | ALL ARE ANTICONVULSANTS (slower/less potent [but more specific] than barbs): membrane stabilization (use in inadvertent IV local anesthetic); also Sz preventative | ALL ARE ANTICONVULSANTS (slower/less potent [but more specific] than barbs): membrane stabilization (use in inadvertent IV local anesthetic); also Sz preventative | No effect d/t weak agonist |
| CV effects | Minimal Cardiac Effects; more effects with opiods; as induction agent, acts like pentothol (BP, HR) | LEAST Cardiac Effects | Minimal Cardiac Effects; more effects with opiods | No adverse effects Perhaps d/t weak agonist |
| Resp. Effects | Dose Depedent Depression; synergistic with opiods ANY DOSE CAN CAUSE APNEA | Dose Depedent Depression; synergistic with opiods ANY DOSE CAN CAUSE APNEA | Dose Depedent Depression; synergistic with opiods ANY DOSE CAN CAUSE APNEA | Depression not completely reversed |
| Clearance | Eliminated in Urine | Eliminated in Urine | Eliminated in Urine | Very Rapid |
| E1/2 | 2 hrs | 15 hrs | 30 hrs (directly r/t age, up to 2x) | 1 hr |
| Metabolism Type | Hydroxylation and Conjugation | Hydroxylation and Conjugation | Hydroxylation and Conjugation | (blank) |
| Metabolism | No change for age/liver dx; CCB, E-mycin, **Fentanyl** interfere | No change for age; Prolonged for liver failure | Prolonged for age (2x)/ liver dx (5X); Cimetidine interferes | No change for age/liver dx |
| Metabolites | 2 Active: clinically irrelevant unless extreme renal failure (1- & 4-hydroxymidazolam) | (inactive) | 2 Active: Desmethyldiazepam (2x t1/2) Oxazepam (Serax) | (inactive) |
| (blank) | Midazolam | Lorazepam | Diazepam | Flumazenil |
| Enzyme Induction (ETOH is enzyme inducer!!) | CYP450: inducer - rapid metabolism competitor - slower metabolism | CYP450: inducer - rapid metabolism competitor - slower metabolism | CYP450: inducer - rapid metabolism competitor - slower metabolism | (blank) |
| IV Induction/ Infusion | 0.1-0.2 mg/kg, then 0.25-1 mcg/kg/min | (blank) | (blank) | (blank) |
| Misc. Trivia | Can be used for induction - not very smooth; takes longer to induce & emerge than STP; Little PONV/ emergence excitement; No delay in d/c times; Decrease dose for opioids, MAC, elderly, other CNS depressant; doesn't accum as much as Fent/ST | Very thick solution; Limits emergence delirium from Ketamine | Thick solution (organic sol); painful injection; less pain, thrombophlebitis w/ soy formulation; AVIOD IM inj; dec albumin may inc onset and effects @ start; 90-100% bioavailable; USE: evening preop sedation; skeletal musc rela | May need more before BZDPs wear off; requires continuous monitoring |
| Dose Adjust | Peds: 0.2 mg/kg IN or 0.5 mg/kg po onset 10-15 min | Decrease in elderly | Decrease in elderly | (blank) |
Created by:
jestevenson
Popular Nursing sets