anxiety

Question 1

acute treatment

Answer 1

benzodiazepine - short term use, lowest effective use

Question 2

chronic treatment

Answer 2

SSRI - sertraline, citalopram, escitalopram, fluoxetine

if someone has physical symptoms of anxiety (tremors, rapid heart rate) - propranolol - alleviates physical symptoms ONLY

Question 3

benzodiazepines imp points

Answer 3

can induce hepatic coma - especially long acting
- treat with lowest dose for shortest period

long acting benzos - diazepam, alprazolam, clobazam

short acting benzo - lorazepam, oxazepam
- short acting preferred in elderly and hepatic impairment patients
- short acting have greater risk of withdrawal symptoms (use for 2-4 weeks)

can cause paradoxical effects - agitation, hostility, anxious

sedation increased with alcohol, CNS depressants, CYP inhibitors - avoid

avoid driving IF feeling drowsy
- benzos with a legal driving limit - clonazepam, oxazepam, lorazepam, diazepam, flunitrazepam, temazepam

overdose treated by flumazenil

Question 4

benzodiazepine withdrawal

Answer 4

S.E of benzodiazepine - DEPENDENCE - anxiety, sweating, tremor, weight loss

3 step protocol:
1) convert all medications to diazepam and give once nightly dose

2) reduce by 1-2mg (1/10th on larger doses) every 2-4 weeks
- only further withdraw if pt has overcome any withdrawal symptoms

3) reduce further (0.5mg near the end)