Anxiety- Benzos

Question 1

FDA approved BZDs for anxiety

Answer 1

clorazepate, lorazepam, alprazolam, diazepam

Question 2

Relative/absolute CIs for BZD use

Answer 2

Allergy to BZD, substance abuse Hx, myasthenia gravis, severe hepatic disease, respiratory disorders (COPD, sleep apnea), pregnancy/lactation, narrow angle glaucoma, BBW with opiates

Question 3

BZDs likely to cause anterograde amnesia

Answer 3

alprazolam, triazolam

Question 4

BZD side effects

Answer 4

Can cause irritability, aggression, excitation, and impulsivity

Question 5

Symptoms of BZD withdrawal

Answer 5

rebound anxiety, recurrence/relapse, withdrawal seizures, can worsen already existing symptoms

Question 6

How to taper BZDs

Answer 6

Reduce by 25%/week until 50% of the dose is reached, then decrease dose by 1/8 every 4-7 days

Question 7

Length of BZD taper for therapy >8 weeks

Answer 7

2-3 weeks

Question 8

Length of BZD taper for therapy >6 months

Answer 8

4-8 weeks

Question 9

Length of BZD taper for therapy >1 year

Answer 9

2-4 months

Question 10

In GAD, when are BZDs commonly prescribed?

Answer 10

Rapid relief of anxiety symptoms (PRN/STAT)

Question 11

BZDs for elderly patients

Answer 11

lorazepam, oxazepam, temazepam

Question 12

BZDs in pregnancy and lactation

Answer 12

Not recommended- thought to increase cleft lip/palate

Question 13

Less lipophilic BZDs

Answer 13

lorazepam, oxazepam

Question 14

Less lipophilic agents have a ___ rate of absorption and ____onset of effect and ____rate of action.

Answer 14

They have a SLOWER rate of absorption, SLOW onset of effect, and LONGER rate of action.

Question 15

More lipophilic BZDs

Answer 15

diazepam and clorazepate

Question 16

High potency BZDs

Answer 16

clonazepam, alprazolam

Question 17

More lipophilic agents have a ___rate of absorption and ____onset of effect and _____duration of action.

Answer 17

They have a FASTER rate of absorption, RAPID onset of effect, and SHORTER duration of action.

Question 18

IM BZD that’s the best for rapid relief

Answer 18

Lorazepam

Question 19

BZDs with shorter half-lives

Answer 19

Alprazolam, lorazepam, oxazepam

Question 20

BZDs with longer half-lives

Answer 20

Diazepam, chlordiazepide, oxazepam

Question 21

BZDs preferred in PAD

Answer 21

High potency BZDs- so alprazolam and clonazepam

Question 22

Don’t use BZDs as monotherapy in those with a history of what disorder?

Answer 22

MDD

Question 23

In PAD, what can you add a BZD to for a more rapid response?

Answer 23

AD!

Question 24

Clinical pearl about clorazepate

Answer 24

Needs acid in the stomach in order for it to work- its effectiveness decreases with PPIs, Tums, etc.