Anxiety + ADHD QA

Question 1

Treatment for anxiety

Answer 1

1) Short acting Benzodiazepines
2) Long acting Benzodiazepines
3) Beta blockers
4) Busprione – 5HT1a agonist

Question 2

Short acting benzodiazepines examples

Answer 2

o Lorazepam
o Oxazepam
o Short acting benzodiazepines should be used in elderly, liver impairment but it carries a greater risk of withdrawal symptoms

Question 3

Long acting Benzodiazepines examples

Answer 3

• Alprazolam
• Clobazam
• Chloidiazepoxide
• Diazepam

Question 4

Examples of 5HT1a agonist

Risk and issues

Answer 4

Buspirone

Low potential for abuse and dependence . Takes two weeks to work.

Question 5

Side effects of Benzodiazepines

Answer 5

• Paradoxical increase in hostility aggression
• Overdose (respiratory depression and coma)
• Sedation (avoid alcohol)
• Dependence (avoid long term use + abrupt withdrawal)

Question 6

Sighs of benzodiazepine withdrawal

Answer 6

Anxiety / Weight loss. Tremors / Sweating / Loss of appetite / Perceptual disorders / Tinnitus

Question 7

How long does Benzodiazepines withdrawal take to occur

Answer 7

Long acting – 3wks

Short acting – one day

Question 8

How to withdraw from Benzodiazepines

Answer 8

1) Convert to equivalent diazepam dose ON
2) Reduce diazepam dose by 1-2mg increments every 2-4wks
3) Reduce diazepam dose further with smaller steps of 500mcg

Question 9

Drug interaction of Benzodiazapines

Answer 9

Increased sedation and CNS effects (Alcohol / Opiods / Antihistamines / Antidepressants – sedating drugs)
Increased plasma concentration (Amiodarone, Diltiazem. Macrolides, Fluconazole – all enzyme inhibitors)

Question 10

ADHD Treatment options in children under 5

Answer 10

FIRST LINE - Methylphenidate hydrochloride
o
SECOND LINE - Lisdexamfetamine mesilate

Question 11

ADHD Drug treatment options in adults

Answer 11

First line: Methylphenidate / Lisdexamfetamine

Alternative : Atomoxetine

Question 12

What do you give if patients cant tolerate Lisdexamfetamine

Answer 12

Give dexamphetamine

Question 13

Side effects of ADHD medication

Answer 13

• Appetite loss / Insomnia / Weight loss
• Tourettes
• Growth restrictions 9pt should have drug free period)
• Increased heart rate and BP

Question 14

Signs of overdose CNS stimulants

Answer 14

• Wakefulness
• Hyperactivity
• Paranoia
• Often these symptoms are followed by exhaustion / convulsions / hyperthermia and coma

Question 15

Monitoring of CNS stimulants

Answer 15

• Growth in children every 6 months

- Psychiatric symptoms – Depression / Psychosis and Suicidal Ideation

Question 16

Contraindications of CNS stimulants

Answer 16

-	CVD 
o	Hyperthyroidism 
o	Severe hypertension 
o	Uncontrolled bipolar 
o	Depression