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cns > Anxiety > Flashcards

Anxiety Flashcards

1
Q

How do you treat acute anxiety?

A

Benzodiazepines

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2
Q

How do you treat chronic anxiety?

A

SSRI’s: sertraline, citalopram, escitalopram and fluoxetine
Propranolol - alleviates symptoms only

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3
Q

What are long acting benzodiazepines?

A

Diazepam, Alprazolam, Chlordiazepoxide hydrochloride and Clobazam

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4
Q

What are the short acting benzodiazepines?

A

Lorazepam and Oxazepam

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5
Q

In what patients are short acting benzodiazepines preferred?

A

Hepatic impairment and the elderly
Greater risk of withdrawal syndromes
Use for 2-4 weeks.

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6
Q

Side effects of benzodiazepines

A

Paradoxical effects: Aggression, hostility, talkative, anxious, excited etc
Sedation increased with use of alcohol, CNS depressants or CYP enzyme inhibitors

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7
Q

What benzos have a legal driving limit?

A

Clonazepam, Oxazepam, Lorazepam, Diazepam, Flunitrazepam and Temazepam
COLD TF

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8
Q

How do you treat benzodiazepine overdose?

A

Flumazenil

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9
Q

What are the withdrawal symptoms

A

Anxiety, sweating, weight loss, tremors, loss of appetite

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10
Q

How to treat benzo withdrawal

A

Convert all medications to a once nightly dose of diazepam
Reduce by 1-2mg (1/10th on larger doses) every 2-4 weeks
Reduce further (0.5mg near the end)

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11
Q

What SSRI is licensed age 5-17

A

Fluoxetine

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12
Q

What is the max dose of citalopram in the elderly?

A

20mg OD
Usually its 40mg if not elderly

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13
Q

What SSRI can prolong QT interval?

A

Citalopram

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14
Q

What is the first like SSRI?

A

Sertraline

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15
Q

What is the SSRI that’s best for patients with multiple chronic diseases?

A

Sertraline

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16
Q

What is the only licensed beta blocker for anxiety?

A

Propranolol

17
Q

What can occur within the first few weeks after starting an SSRI?

A

Increased risk of agitation, anxiety and suicidal ideation. Continue on therapy and provide crisis team contact details.

18
Q

When a patient is newly started on an SSRI, how often should they have reviews?

A

Every 2-4 weeks for three months and then if good response, longer intervals can be left.

19
Q

What are the symptoms someone should be aware of when on an SSRI?

A

GI bleed: Black or red stools. When taken with NSAID’s can increase the risk of bleed
Hyponatraemia: Muscle weakness, spasms, cramps, confusion
Jaundice: yellowing of the skin and eyes
Serotonin syndrome.

20
Q

What are the risks of stopping an SSRI abruptly?

A

GI disturbances, electric shock sensation, tinnitus, sleep disturbances, fatigue, flu like symptoms

21
Q

What should be considered before a patient can try another medication after being on an SSRI?

A

Needs to be a washout period otherwise runs the risk of serotonin syndrome. Cross tapering should be considered.

cns (15 decks)

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