Anxiety Flashcards
Anxiety Treatment - Benzodiazipines
Are what kind of treatment? For the lowest possible what?
short term treatment for lowest possible dose
Chronic Anxiety are used treated with what? What do they do and for who??
SSRIs,citalopram,escitalorapm,fluoxetine,propranolol-alleviates symptoms only (for something really bad - only physical not mind)
Benzo Cautions - what age group patients?? What can it induce?? Especially long acting benzos ( how do we use their treatment???)
careful especially in elderly- can induce a hepatic coma, especially long acting benzodiazipines(treat with lowest dose for shortest period of time possible)
Long acting Benzos - examples?
diazepam,alprazalam, chloridiazepoxide,clobazam
Short acting benzos - who is it preferred in?? Which patients??? MOL
lorazepam and oxazepam,midazolam - short acting preferred in patients with hepatic impairment/elderly
Short acting - Can carry a greater risk of what?? So we only use it for how long???
- Short acting carry greater risk of withdrawal - only used for 2-4 weeks
Can cause paradoxical effects - benzos relax but what can they do to some patients??
What is this increased by?? Avoid driving if you feel?? Which are safe to use whilst driving??? What is overdose treated with???
aggression,hostility,talkative,excited
- Can cause sedation - increased with alcohol,CNS depressant or CYP Enzyme inhibitors-avoided concomitant use
- Avoid driving if feeling drowsy - benzodiazepines that have a legal limit: Clonazepams,oxazepams,lorazepam,diazepam,flunitrazepam,temazepam (COLD FT)
- Overdose treated with Flumazenil
- It’s okay to drive,avoid driving if feeling drowsy
Benzodiazepines withdrawal: what are the symptoms of dependence? What are the steps of reducing dose??????
- Dependence:anxiety,sweating,weight loss,tremors,loss of appetite
- 1)convert all medication into a once nightly dose of diazepam
- 2)reduce by 1-2mg (1/10th on larger doses)every 2 to 4 weeks
- Only further withdraw if patient has overcome any withdrawal
3) Reduce further(0.5mg near the end)
Hypnotics and anxiolytics
What do anxiolytics induce? What are they also known as?? When they are given when And examples of this? Dependence does what and so as a result …… for a of time
What are most commonly used … they act at which receptors?? Associated with what? Older drugs like what are no longer recommended? Because of what? Meprobamate? Barbituates
- Most anxiolytics (sedatives) will induce sleep(sleeping pills) when given at night eg, temazepam and most hypnotics wild sedate when given during the day eg.Diazepam
- Dependence (physical and physiological) and tolerance can occur which may lead to difficulty in withdrawing the drug after the patient has been taking it regularly for more than a few weeks
- Therefore, use only short term and lowest doses possible
- Benzodiazepines are the most commonly used anxiolytics and hypnotics
- They act at the benzodiazepines receptors which are associated with Gamma-amionbutyric acid(GABA)Receptors
- -older drugs like meprobamate and barbiturates are not recommended due to their interactions, side effects and dangerous in overdose
Anxiolytics which are effective? In alleviating what states? What are they not appropriate in use of what can bdz inhibit? Who is dependence likely in? Limit treatment to what? What can beta blockers do? Who are they indicated in
- Benzodiazepines are effective in alleviating anxiety states
- They are not appropriate for use in stress,unhappiness or minor physical disease
- Benzodiazepines can inhibit psychological adjustment in bereavement
- Dependence particularly likely in patients with history of alcohol or drug abuse and with marked personality disorders
- Limit treatment to lowest possible dose for shortest period of time
Beta blockers do not affects psychological symptoms of anxiety - worry, fear, tension - but they reduce autonomic symptoms eg palpitations and tremor. Indicated in patients with predominantly somatic symptoms
