Anixety Flashcards
Anxiety
Feeling of worry or unease about the future, with psychological and physical symptoms.
Excessive or persistent = sign of an anxiety disorder.
Psychological symptoms
Restlessness
Worry
Fear
Difficulty concentrating
Irritability
Physical symptoms
Palpitation
Muscle aches + tension
Trembling or shaking
Excessive sweating
Shortness of breath
Insomnia
Benzodiazepines
CD 4 Part 1
Split into longer-acting and shorter-acting
Only indicated for the short-term relief (2-4 weeks) of anxiety that is severe or disabling, occurring with or without insomnia.
Long-acting BDZ
Diazepam
Clobazam (adjunct in epilepsy)
Chlordiazepoxide (adjunct in acute alcohol withdrawal)
Alprazolam
Shorter-acting BDZ
TOLLL
Temazepam
Oxazepam
Lorazepam
Loprazolam
Lormetazepam
Use in elderly + liver impairment
Greater risk of withdrawal symptoms
BDZ - Side effects
Drowsiness
Light-headedness (the next day)
Confusion
Ataxia
BDZ - overdose
Drowsiness
Ataxia
Dysarthria
Nystagmus
Respiratory depression and coma (rare but can happen if loss of airway reflexes)
Sedation
Coma
Activated charcoal - given within 1 hour of ingesting. patient must be awake and airway protected.
BDZ- Paradoxical effects
BDZ cause a paradoxical increase in hostility and aggression e.g. talkativeness, excitement and aggressive antisocial acts
BDZ - Elderly
Should be avoided in the elderly.
Lower dose if used
Increased risk of confusion = falls and injury
BDZ - Dependence and withdrawal
Used for 4+ weeks = risk of dependence and withdrawal reaction.
Avoid long-term use
Avoid abrupt withdrawal
BDZ - Withdrawal syndrome
Occurs within a day of stopping a short-acting BDZ
Occurs within 3 weeks of stopping a long-acting BDZ
Increased:
- Anxiety
- Insomnia
- Weight loss
- Tremors
- Sweating
- Loss of appetite
- Perceptual disorders
- Tinnitus
BDZ - Withdrawal management
- Gradually convert (over 1 week) to equivalent Diazepam dose ON
- Reduce Diazepam dose by 1-2 mg increments every 2-3 weeks (up to 1/10th every 1-2 weeks for higher doses)
- Reduce diazepam dose further (can reduce in smaller steps of 500 mcg towards the end)
BDZ - Avoid
Respiratory impairment
Neuromuscular disease
Liver failure - may precipitate hepatic encelopathy. If necessary, use lorazepam (elimination is less dependent on the liver)
BDZ - Interactions (increased Cp)
Eliminated by CYP enzymes.
Avoid concurrent use with CYP inhibitors (reduced elimination = increased Cp):
- Amiodarone
- Diltiazem
- Macrolides
- Fluconazole
- Protease inhibitors
