Some benzodiazepines are used as antiepileptic agents. These include clobazam (Onfi), clonazepam (Klonopin), and diazepam (Valium).
有些苯二氮卓类药作为抗癫痫药使用，这些药物包括氯巴占（昂非）、氯硝西泮（克诺平）、地西泮（烦宁）。
Therapeutic Actions and Indications 治疗作用和适应症
The benzodiazepines may potentiate the effects of GABA, an inhibitory neurotransmitter that stabilizes nerve cell membranes. These drugs, which appear to act primarily in the limbic system and the RAS, also cause muscle relaxation and relieve anxiety without affecting cortical functioning substantially. The benzodiazepines stabilize nerve membranes throughout the CNS to decrease excitability and hyperexcitability to stimulation. By decreasing conduction through nerve pathways, they reduce the tonic–clonic, muscular, and emotional responses to stimulation. In general, these drugs have limited toxicity and are well tolerated by most people.
苯二氮卓类可以增强GABA的效应。GABA为抑制性神经递质，可以稳定神经细胞膜。这些药物主要作用于边缘系统和RAS，还可以引起肌肉放松，缓解焦虑，不会实质性影响皮质功能。苯二氮卓类稳定CNS神经膜，降低对刺激的兴奋和超兴奋性。通过减少神经通路传导，这些药物还可降低对刺激的强直-阵挛、肌肉和情感反应。一般说来，这些药物具有有限的毒性，多数人耐受佳。
Clonazepam may lose its effectiveness within 3 months (affected patients may respond to dose adjustment). Clobazam, the newest drug in this class, is indicated for adjunct treatment of seizures associated with Lennox-Gastaut syndrome in patients 2 years of age and older.
氯硝西泮可在3个月内失去其效果（受影响患者可通过剂量调整作出响应）。氯巴占是本类药物中的新药，适用于2岁以上L-G综合征相关癫痫的辅助治疗。
Pharmacokinetics 药代动力学
Diazepam is available in oral and rectal forms. Clonazepam is now available in an orally disintegrating tablet, making it a good choice for patients who have difficulty swallowing capsules or tablets. Clobazam is available in oral form only. These agents are well absorbed from the GI tract, metabolized in the liver, and excreted in the urine. They have a long half-life of 18 to 50 hours.
地西泮分口服型和直肠剂型。氯硝西泮目前已出口腔崩解片，这使它成为胶囊或片剂吞咽困难的患者的良好选择。氯巴占只有口服剂型。这些药物胃肠道吸收佳，经肝代谢，随尿排出。半衰期长，达18 – 50小时。
Adverse Effects 不良效应
The most common adverse effects associated with benzodiazepines relate to CNS depression and its effects on body function: Depression, confusion, drowsiness, lethargy, fatigue, constipation, dry mouth, anorexia, cardiac arrhythmias, and changes in blood pressure, urinary retention, and loss of libido. Benzodiazepines may be associated with physical dependence and withdrawal syndrome, especially with rapid reduction in dose.
苯二氮卓类药最常见不良效应与CNS抑制及其对身体功能的效应有关：抑郁、意识错乱、瞌睡、倦怠、疲劳、便秘、口干、厌食、心律异常、血压变化、尿潴留、性欲缺乏。苯二氮卓类药可能与躯体依赖和戒断综合征存在相关性，尤其是在剂量快速减少时。
★Vocabulary for Today ★
benzodiazepines – n. 苯二氮卓类
antiepileptic – a. 抗癫痫的
clobazam – n. 氯巴占
Onfi – n. 昂非
clonazepam – n. 氯硝西泮
Klonopin – n. 克诺平
diazepam – n. 地西泮
Valium – n. 烦宁
potentiate – v. 强化，增强
GABA – n. γ-氨基丁胺
inhibitory – a. 抑制的
limbic – a. 边的，缘的
adjunct – a. 附加的，附属的
Lennox-Gastaut syndrome – n. 伦-格综合征
disintegrating tablet – 崩解片
1. Select all that apply that is appropriate when there is a benzodiazepine overdose:
A. Administration of syrup of ipecac
B. Gastric lavage
C. Activated charcoal and a saline cathartic
D. Hemodialysis
E. Administration of Flumazenil 2. When monitoring a client who is taking benzodiazepines, the nurse should be alert for which CNS side effects?
A. Blurred vision, anorexia, dysarthria
B. Seizures, tremors, diaphoresis
C. Ataxia, sedation, dizziness
D. Libido changes, edema, dystonia
1. B, C, and E.
Rationale:
If ingestion is recent, decontamination of the GI system is indicated. The administration of syrup of ipecac is contraindicated because of aspiration risks related to sedation. Gastric lavage is generally the best and most effective means of gastric decontamination. Activated charcoal and a saline cathartic may be administered to remove any remaining drug. Hemodialysis is not useful in the treatment of benzodiazepine overdose. Flumazenil can be used to acutely reverse the sedative effects of benzodiazepines, though this is normally done only in cases of extreme overdose or sedation. 2. C. Ataxia, sedation, dizziness. Rationale:
These are common side effects. Anorexia is a GI effect. Choice B are the result of acute withdrawal. Libido and edema are not CNS-related side effects.
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