Anxiety

Question 1

Daily or PRN dosing for Anxiety disorder

Answer 1

Take daily

Not prn

Question 2

Benzodiazepines

Long term
5

Answer 2

Clobazem
Clonazepam
Diazepam
Flunitrazepam
Nitrazepam

Question 3

Benzodiazepines

Medium acting
2

Answer 3

Bromazepam
Lorazepam

Question 4

Benzodiazepines

Short acting
3

Answer 4

Alprazolam
Oxazepam
Temazepam

Question 5

How long do you need to take benzodiazepine to become dependant

Answer 5

More than 1 month = risk of dependence, tolerance, misuse

Question 6

Symptoms of benzo withdrawal

Answer 6

Anxiety insomnia, tremor, nausea

Question 7

Treatment of
Benzodiazepine withdrawal

Answer 7

Stabilise on diazepam equivalent before dose reduction

Question 8

DRUG Alternative to BDZ
(for ppl with history of drug dependence)

Answer 8

Busperione (buspar)

Question 9

Non-BDZ, BDZ Receptor Modulator (Z drugs)
Binding?
Names 2

Answer 9

To receptors containing alpha1 subunit

Zolpidem
Zopiclone

Question 10

Does zolpidem require a warning?

Answer 10

Yes black box warning when first approved.

Question 11

Other GABAergic drugs

Answer 11

Tiagabine ( GABA reuptake inhibitor)

Gabapentin and pregablin ( structural analogues of GABA)

Question 12

Moa of Buspirone

Answer 12

Partial agonist at serotonin 5HT1A receptors.

Question 13

BDZs drug interactions?

Answer 13

CYP3A4

Alcohol

Question 14

Cellular Mechanism that leads to BDZ addiction?

Answer 14

1. GABAergic neurons interaction with alpha 1 Receptor types, and dampen down the activity of the neuron.
2. When BDZ is added
   It potentates that inhibition and lowers the GABA production and dampens down the alpha 3 Receptor

Question 15

How to taper down BDZ

Answer 15

Slowly by 25 to 50% of the daily dose each week to Month. (Based on response)

1. Converting to long acting BDZ not required I’d patient is taking a short acting BDZ
2. SLOWER weaning when reducing to final lowest dose (12.5%)
3. End treatment 2 weeks after giving the lowest dose