Benzodiazepines

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• Mechanism of action: agonism of the GABAA receptor, a ligand-gated chloride channel, that results in hyperpolarization of neurons
  1. Lorazepam (Ativan^®)
     • Dose and route 
       • PO/IM/IV: 0.5-2 mg 
     • Onset of action 
       • IV: 10 min
       • PO/IM: >20 min
     • Duration 
       • PO: 12 hrs
       • IV/IM: 6-8 hrs
  2. Midazolam (Versed^®)
     • Dose and route 
       • IV/IM: 2.5-5 mg
     • Onset of action 
       • IV/IM: 5-10 min
     • Duration 
       • IV/IM: 1-2 hrs

Midazolam has a faster onset, but it also has an active metabolite. Caution in older individuals or those with hepatic or renal impairment. 

• Comes in two different concentrations- 2mg/2mL and 5mg/1mL. The 5mg/1mL is typically preferred if administering IM.

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• Effects
  • Sedation, muscle relaxation, anxiolysis, hypnosis
• Adverse Effects
  • Respiratory depression, hypotension, oversedation OR paradoxical agitation
• Caution
  • Alcohol/sedative intoxication, respiratory issues, elderly, dementia

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• Controversies
  • Oversedates some, but fails to sedate others…which one?