Antianxiety meds

Question 1

Benzodiazapine (BZD) drug lists

Answer 1

1. Alprazolam/Xanax
2. Clonazepam/Klonopin
3. Diazepam/Valium
4. Lorazepam/Ativan

Question 2

alprazolam

Answer 2

xanax

Question 3

clonazepam

Answer 3

klonopin

Question 4

diazepam

Answer 4

valium

Question 5

lorazepam

Answer 5

ativan

Question 6

BZD mechanisms

Answer 6

enhance GABA neurotransmission

Question 7

long acting BZDs

Answer 7

clonazepam

diazepa

Question 8

short acting BZDs

Answer 8

alprazolam

lorazepam

Question 9

Efficacy of BZDs

Answer 9

1. quick onset
2. anxiolytic
3. hypnotic
4. muscle relaxation
5. anticonvulsant (DOC for epilepsy) **
6. amnesic

Question 10

BZD side effects

Answer 10

tolerance/dependence (difficult to taper, caution in patients with substance abuse, potential for w/d)

CNS depression

Question 11

BZD in elderly

Answer 11

use BZD with little renal clearance

LOTs: lorazepam, oxazepam, temazapam

Question 12

BBW of BZDs

Answer 12

concomitant use of bends and opioids may result in death, coma, respiratory depression

Question 13

BZDs schedule

Answer 13

IV controlled

limited to 5 refills/6 month

Question 14

Buspirone

Answer 14

Buspar

mechanism unknown

use for those w/SA issues (not dependent)

drawback: long onset, TID dosing due to short half life

Question 15

Pregabalin

Answer 15

lyrica

Question 16

gabapentin

Answer 16

neurontin

Question 17

Pregabalin/gabapentin

mechanism

Answer 17

NOT synthetic GABA

instead- inhibits glutamate release

glutamate antagonist

Question 18

controlled level: Lyrica

Answer 18

CV substance

Question 19

control level: gabapentin

Answer 19

neurotin

CVI – reported to OARRS

Question 20

Lyrica/Neurotin side effects

Answer 20

CNS depression

dose accumulation w/ renal insufficiency

Question 21

anti-depressants and anxiety

Answer 21

SSRIs are D.O.C. for several anxiety disorders

some SNRI

may worsen anxiety

Question 22

other agents used in anxiety disorders

Answer 22

1. B-Blockers
2. MAOIs
3. Antihistamines
4. Barbituates
5. Pregabalin/Gabapentin
6. Antipsychoitcs

Question 23

beta blockers in anxiety (use)

Answer 23

symptom control (tachycardia)

Question 24

Antihistamines with anxiety

Answer 24

hydroxyzine

also used for sedating properties

Question 25

Recommendations: generalized anxiety disorders

Answer 25

1. antidepressants
2. BZDs
3. Buspirone
4. Pregabalin, SGAs, valproate
5. CBT, psychotherapy

Question 26

Recommendations: panic disorders

Answer 26

1. antidepressants
2. BZDs
3. CBT, psychotherapy

**buspirone, BBs, antihistamine, SGAs, bupropion, trazodone NOT shown to be effective

– lose adjuncts

Question 27

Recommendations:

OCD

Answer 27

1. Serotonergic agents effective: SSRI
2. CBT augmenting SSRI
3. Augmentation with haloperidol or SGA may help

** NO benzos

Question 28

Recommendations:

PTSD

Answer 28

1. SSRIs
2. Augment with other agents for specific symptoms
3. BZDs
4. Trauma-focused CBT

Question 29

other agents used in PTSD

Answer 29

prazosin
anticonvlusants
SGAs

Question 30

Prazosin

Answer 30

alpha-1 antagonist

used for PTSD associated nightmares

Question 31

anticonvulsants

Answer 31

used for aggression, anger, depression

Question 32

SGAs PTSD

Answer 32

used for psychotic symptoms

Question 33

Recommendations: social anxiety disorder

Answer 33

1. CBT most effective
2. Antidepressants (12 weeks to work)
3. BZDs as adjunct
4. Gabapentin/Pregabalin