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Sedative Hypnotic Anxiolytics: Benzodiazepines Cheat Sheet by

Alprazolam Diazepam Lorazepam Chloridazepoxide Oxazepam Clonazepam




Expected Pharma­col­ogical Action
Therap­eutic Uses
Benzod­iaz­epines enhance the inhibitory effects of gamma-­ami­nob­utyric acid (GAMA) in the CNS.
For genera­lized anxiety disorder (GAD) and panic disorder
Relief from anxiety occurs rapidly following admini­str­ation.
Trauma and stressor related disorders: acute stress disorders (ASD) and post-t­rau­matic stress disorder (PTSD.
Short-term use is recomm­ended due to potential for depend­ency.
Hypera­rousal manife­sta­tions of dissoc­iative disorders
Muscle Spasm
Alcohol withdrawal (for prevention and treatment of acute manife­sta­tions)
Induction of anesthesia
Amnesic prior to surgery for procedures


CNS Depres­sants
Client Education
(alcohol, barbit­urates, opioids) can result in respir­atory depres­sion. Antico­nvu­lsants and antihi­sta­mines can cause increased CNS depression
Avoid alcohol and other substances that cause CNS depres­sion. Avoid activities that require alertness (driving)
Grapefruit Juice can reduce metabolism
Avoid the use of grapefruit juice
High-Fat Means can reduce absorption
Do not take with fatty foods


CNS Depression
Client Education
Sedation, lighth­ead­edness, ataxia, decreased cognitive function
Observe for CNS depres­sion. Notify provider if effects occur. Avoid activities that require alertness (driving). Avoid alcohol and other antian­xiety medica­tions due to potential depressant effects such as severe respir­atory depres­sion.
Antero­grade Amnesia
Difficulty recalling events that occur after dosing
Observe for manife­sta­tions. Notify the provider if effects occur
Acute Toxicity. Oral Toxicity (Drows­iness, lethargy, confus­ion). IV Toxicity (can lead to respir­atory depres­sion, severe hypote­nsion, or cardia­c/r­esp­iratory arrest)
Watch for manife­sta­tions. Notify the provider if these occur. For oral toxicity, gastric lavage is used, followed by the admini­str­ation of activated charcoal or saline cathar­tics. Administer flumazenil for benzod­iaz­epine toxicity to counteract sedation and reverse adverse effects. Monitor vital signs, maintain patient airway, and provide fluids to maintain blood pressure. Have resusc­itation equipment available.
Parado­xical Response
Insomnia, excita­tion, euphoria, anxiety, rage
Watch for manife­sta­tions. Notify the provider if these occur.
Withdrawal Effects
Include anxiety, insomnia, diapho­resis, tremors, lighth­ead­edness, delirium, hyperp­igm­ent­ation, muscle twitching, and seizures
Withdrawal effects are not common with short term use. If taking benzod­iaz­epines regularly and in high dose, taper the dose over several weeks

Contra­ind­ica­tions/ Precau­tions

Benzod­iaz­epines are pregnancy risk category D medica­tions that can cause fetal harm, and harm to infants due to transm­ission through human milk. These medica­tions are avoided in clients who are pregnant or breast­fee­ding.
Benzod­iaz­epines are classified under schedule IV of the controlled substance act.
Benzod­iaz­epines are contra­ind­icated in clients who have sleep apnea, respir­atory depres­sion, or glaucoma.
Use benzod­iaz­epines cautiously in older adult clients and those who have liver disease or a history of substance use disorder.
Benzod­iaz­epines are generally used short term due to the risk for depend­ence.

Nursing Admini­str­ation

Client Education
Administer the medica­tions with meals or snacks if gastro­int­estinal upset occurs. Administer the medication at bedtime if possible due to sedation. Advise clients to swallow sustai­ned­-re­lease tablets and avoid chewing or crushing the tablets
Do not take benzod­iaz­epines in larger amounts or more often than prescribed without consulting the provider. Dependency can develop during or after treatment. Notify the provider if indica­tions of withdrawal occur. Store benzod­iaz­epines in a secure place to prevent misuse by others. Swallow sustai­ned­-re­lease tablets and do not crush or chew them.


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