Residual sedation : sedative effects (e.g., drowsiness) persist beyond the intended time span.All benzodiazepines are metabolized by the liver, but these three undergo biotransformation through glucuronidation, not CYP450 activation, and are less affected by liver disease. Lorazepam, Oxazepam, and Temazepam are preferred for individuals who drink a LOT (have alcoholic liver disease), because hepatic dysfunction does not have a strong effect on their metabolism. Other indications include skeletal muscle spasticity, catatonia, eclampsia, sleepwalking, night terrors, and chemotherapy-induced nausea and vomiting.Preoperative and procedural sedation : diazepam, lorazepam, midazolam.Seizures and status epilepticus : diazepam, lorazepam, midazolam, clonazepam.Alcohol withdrawal : chlordiazepoxide, diazepam, oxazepam.
Benzodiazepines decrease the duration of N3 phase in NREM sleep, thereby reducing the occurrence of sleepwalking and night terrorsīenzo increases the frequenzo of Cl-channel opening.Benzodiazepines are in direct GABA A receptor agonists that bind to GABA-A receptors → ↑ affinity of GABA to bind to GABA A receptors → ↑ GABA action → ↑ opening frequency of chloride channels → hyperpolarization of the postsynaptic neuronal membrane → ↓ neuronal excitability.Long-acting : ( half-life > 40 hours) : diazepam, chlordiazepoxide, clonazepam, tetrazepam, flurazepam.Intermediate-acting : ( half-life 12–40 hours) : lorazepam, temazepam, oxazepam, lormetazepam, alprazolam.Short-acting : ( half-life 1–12 hours) : midazolam, triazolam.Sleep disturbances: abnormal dreams, nightmares, sleep terrors.Antagonism of orexin ( hypocretin) receptors → ↓ wakefulness.Activation of MT1 and MT2 receptors in suprachiasmatic nuclei of the hypothalamus → ↓ sleep-onset latency.Generalized-onset and focal-onset seizures.Intermediate-acting: amobarbital, butalbital Short-term treatment for insomnia or anxiety.Short-acting: pentobarbital, secobarbital GABA A receptor agonism → ↓ neuronal excitability in the brain → ↓ ICP and sedative, hypnotic, and antiepileptic effects.Ultra-short acting: thiopental, methohexital Long-acting: diazepam, chlordiazepoxide, clonazepam, tetrazepam, flurazepam Intermediate-acting: lorazepam, temazepam, oxazepam, lormetazepam, alprazolam
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