Anxiety Disorder/Sleep Disorder

Question 1

First-line treatment for anxiety

Answer 1

SSRIs and SNRIs (*not all)

Question 2

Second-line treatment for anxiety

Answer 2

Buspirone (can be used with antidepressants).
Tricyclic antidepressants, Pregabalin, and Propranolol are not FDA approved but are used.
Hydroxyzine (PRN use only d/t sedating effect)

Question 3

Buspirone is a major substrate of what?

Answer 3

CYP3A4 (avoid inhibitors including grapefruit juice!)

Question 4

Benzodiazepine use should be limited to what duration?

Answer 4

no more than 1 to 2 weeks. Should be tapered off slowly

Question 5

Elderly-friendly benzodiazepines

Answer 5

LOT: Lorazepam, Oxazepam, Temazepam (also liver-friendly)

Question 6

Liver-friendly benzodiazepines

Answer 6

LOT: Lorazepam, Oxazepam, Temazepam (also elderly-friendly)

Question 7

Benzodiazepines for anxiety

Answer 7

CLAD: Clonazepam, Lorazepam, Alprazolam, Diazepam

Question 8

Benzodiazepines for sleep

Answer 8

Lorazepam and Temazepam

Question 9

Should BZD be used in pregnant patients?

Answer 9

No. Crosses placenta and causes birth defects and withdrawal syndrome in infants

Question 10

Fast onset BZDs

Answer 10

Diazepam, Temazepam, ChlorazePATE

Question 11

Intermediate onset BZDs

Answer 11

Alprazolam (RxPrep says fast), Lorazepam, ClonazePAM, Chlordiazepoxide

Question 12

Slow onset BZDs

Answer 12

Oxazepam

Question 13

BZDs used for alcohol withdrawal syndrome

Answer 13

Lorazepam, diazepam, chlordiazepoxide

Question 14

Antidote for BZD overdose

Answer 14

flumazenil

Question 15

Treatment to help fall asleep

Answer 15

Eszopiclone, Ramelteon, Zaleplon, Zolpidem

Question 16

Treatment to help stay asleep

Answer 16

Eszopiclone, Doxepin, Suvorexant, Zolpidem

Question 17

Treatment to help both fall and stay asleep

Answer 17

Eszopiclone and Zolpidem

Question 18

Diagnosis criteria for chronic insomnia

Answer 18

insomnia symptoms at least 3 times per week for at least 3 months

Question 19

RLS treatment

Answer 19

pramipexole, ropinirole, rotigotine (patch), and gabapentin

Question 20

Narcolepsy treatment

Answer 20

Daytime Meds: Modafinil, Armodafinil

Nighttime Med: Sodium Oxybate (maybe used in addition to the daytime meds)

Question 21

Very serious SE of Modafinil and Armodafinil

Answer 21

rash that can be life-threatening

Question 22

Why does Sodium Oxybate require REMS

Answer 22

It’s a “date rape” drug. REMS program to make sure it is used for narcolepsy.