Anxiety- Benzos Flashcards
FDA approved BZDs for anxiety
clorazepate, lorazepam, alprazolam, diazepam
Relative/absolute CIs for BZD use
Allergy to BZD, substance abuse Hx, myasthenia gravis, severe hepatic disease, respiratory disorders (COPD, sleep apnea), pregnancy/lactation, narrow angle glaucoma, BBW with opiates
BZDs likely to cause anterograde amnesia
alprazolam, triazolam
BZD side effects
Can cause irritability, aggression, excitation, and impulsivity
Symptoms of BZD withdrawal
rebound anxiety, recurrence/relapse, withdrawal seizures, can worsen already existing symptoms
How to taper BZDs
Reduce by 25%/week until 50% of the dose is reached, then decrease dose by 1/8 every 4-7 days
Length of BZD taper for therapy >8 weeks
2-3 weeks
Length of BZD taper for therapy >6 months
4-8 weeks
Length of BZD taper for therapy >1 year
2-4 months
In GAD, when are BZDs commonly prescribed?
Rapid relief of anxiety symptoms (PRN/STAT)
BZDs for elderly patients
lorazepam, oxazepam, temazepam
BZDs in pregnancy and lactation
Not recommended- thought to increase cleft lip/palate
Less lipophilic BZDs
lorazepam, oxazepam
Less lipophilic agents have a ___ rate of absorption and ____onset of effect and ____rate of action.
They have a SLOWER rate of absorption, SLOW onset of effect, and LONGER rate of action.
More lipophilic BZDs
diazepam and clorazepate
High potency BZDs
clonazepam, alprazolam
More lipophilic agents have a ___rate of absorption and ____onset of effect and _____duration of action.
They have a FASTER rate of absorption, RAPID onset of effect, and SHORTER duration of action.
IM BZD that’s the best for rapid relief
Lorazepam
BZDs with shorter half-lives
Alprazolam, lorazepam, oxazepam
BZDs with longer half-lives
Diazepam, chlordiazepide, oxazepam
BZDs preferred in PAD
High potency BZDs- so alprazolam and clonazepam
Don’t use BZDs as monotherapy in those with a history of what disorder?
MDD
In PAD, what can you add a BZD to for a more rapid response?
AD!
Clinical pearl about clorazepate
Needs acid in the stomach in order for it to work- its effectiveness decreases with PPIs, Tums, etc.
