Anxiety and insomnia Flashcards
What are anxiolytics
Sedatives
What are the most common anxiolytics and hypnotics
Benzodiazepines
Name some anxiolytics and hypnotics
Hypnotics - Benzos, Z drugs, promethazine, melatonin, clomethiazole
Anxiolytics - Benzos, buspirone meprobamate, barbiturates
Why should anxiolytics and hypnotics be reserved for short term use only
Risk of dependence and difficulty in withdrawing the drug
Should you use benzos for mild anxiety
No - risk of dependence
How should you reduce benzos
Gradually, otherwise can lead to benzodiazepine withdrawal syndrome that can start anywhere up to 3 weeks later
Long term benzos withdrawal protocol
Transfer to equivalent daily dose of diazepam, preferably at night and reduce (1-2mg every 2 to 4 weeks)
How long does it take for the withdrawal symptoms of benzos to resolve
6 to 18 months
Side effects of benzos
Drowsiness and light-headedness the next day, confusion and ataxia
Overdose - drowsiness, ataxia, respiratory depression and coma
What can be used for panic attacks
IV diazepam
IV Lorazepam
What impairment must we watch out for
Hepatic- benzos are cleared hepatically so the drugs can precipitate coma. Avoid in severe hepatic impairment
What does alcohol do when using with benzos
Effect of benzos enhanced with alcohol use so more chances of developing dependence for benzodiazepines
Name some benzodiazepine withdrawal symptoms
Insomnia
Anxiety
Loss of appetite and weight
Tremor
Benzo reversible agent
Activated Charcoal
What should be done when treating paradoxical effects (increase in hostility, anxiety and aggression)
Adjust doses up or down
Benzos contraindications
Acute pulmonary insufficiency
Unstable myasthenia gravis
Sleep apnoea
Should benzos be used in pregnancy
No - risk of neonatal withdrawal symptoms
Name some short acting and long acting benzos
Short acting - TOLL
Temazepam
Oxazepam
Loprazolam
Lorazepam
Long acting
Nitrazepam
Flurazepam
Diazepam
Alprazolam
Chlordiazepoxide
Clobazam
What drugs are helpful in dental patients
Temazepam
Diazepam - can also be given at night if pt suffers from daytime anxiety so that the next day is anxiety free
Temazepam preferred when it is important to minimise effects the next day
Why is clomethiazole helpful in elderly
No hangover effect
What is the issue with promethazine
Prolonged duration of action can cause drowsiness the next day aswell
Why is alcohol a poor sleep hypnotic
It can cause diuretic action so people may need the toilet in the further part of the night - can disrupt sleep patterns
When is melatonin used
Insomnia in adults over 55
Short term jet lag
What benzos are used in hepatic impairment
LLATOM
Lormetazepam. Loprazolam, temazepam, oxazepam, midazolam, alprazolam
What is the key point with buspirone
Does not alleviate symptoms of benzo withdrawal - must still withdraw benzos gradually
What is the issue with meprobamate (it isnt in the BNF)
Less effective than benzos
More hazardous in overdose
Dependence
Not recommended
When are barbiturates used?
Only recommended in severe, intractable insomnia
Avoid in elderly
