Anxiety Disorders Flashcards
two basic componenents of anxiety
Mental and Physical features
define anxiety
uncomfortable feeling of vague fear or apprehension accompanied by physical sensations
anxiety disorders differ from anxiety how
more intense and last for longer
development of avoidance, ritual acts, or repetitive thoughts to protect
length of time for symptoms to be diagnosed with generalized anxiety disorder
6 months
to be diagnosed with anxiety disorder a person must have 3+ of the following
restlessness or keyed up or on edge easily fatigued difficulty concentrating or mind going blank irritability muscle tension sleep disturbances
benzodiazepines for generalized anxiety disorder
alprazolam chlordiazepoxide clonazepam clorazepate diazepam lorazepam midazolam oxazepam
brand name of alprazolam
xanax
chlordiazepoxide brand name
librium
clonazepam brand name
klonopin
clorazepate brand name
tranxene
diazepam brand name
valium
lorazepam brand name
ativan
midazolam brand name
versed
oxazepam brand name
serax
which benzos are most commonly seen in GAD
alprazolam
clonazepam
diazepam
lorazepam
alprazolam onset
intermediate
alprazolam distribution half life
intermediate
alprazolam elimination half life
6-20 hours
alprazolam oral dosage equivalency
1 mg
clonazepam oral dosage equivalency
0.5 mg
clonazepam onset
intermediate
clonazepam distribution half life
intermediate
clonazepam elimination half life
18-50 hours
diazepam oral dose equivalency
10 mg
diazepam onset
rapid
diazepam distribution half life
rapid
diazepam elimination half life
30-100 hours
lorazepam dosage equivalency
2 mg
lorazepam onset
intermediate
lorazepam distribution half life
intermediate
lorazepam elimination half life
10-20 hours
oxazepam dosage equivalency
30 mg
oxazepam onset
slow
oxazepam distribution half life
intermediate
oxazepam elimination half life
8-12 hours
oral and sublingual BZDs achieve peak plasma levels when
1-3 hours
which 3 BZDs are compounded for oral or sublingual use
lorazepam
alprazolam
triazolam
which BZDs are available in injectable forms
chlordiazepoxide
diazepam
lorazepam
midazolam
Which injectable BZD is most commonly used in pre-op
midazolam
Which 2 injectable BZDs are most commonly seen
lorazepam
midazolam
which 2 BZDs should have IM injection avoided
diazepam
chlordiazepoxide
When are IM injections of BZDs seen
psychomotor agitations
when are IV injections of BZDs seen
seizures and pre-op sedation
psych with acute dystonic reaction
which site of IM injection has better absorption
deltoid
onset of effect depends on what properties of BZDs
lipophilicity
high -> rapidly absorbed effect in 30-60 minutes
Which BZDs are highly lipophilic
diazepam
clorazepate
which BZDs are less lipophilic
diazepam
lorazepam
oxazepam
duration of effect after a single dose depends on what factor
distribution half life
duration of effect after multiple doses depends on what factor
elimination half life
Which drug is the IM DOC in psychiatry
lorazepam
which BZDs have active metabolites of little importance
alprazolam
triazolam
midazolam
which BZDs have no active metabolites
lorazepam
oxazepam
temazepam
which BZDs are choice in elderly and liver disease
no active metabolites
lorazepam
oxazepam
temazepam
drug interactions with BZDs
alcohol
clozapine
BZD interaction with alcohol
decreased clearance of chlordiazepoxide and diazepam
additive psychomotor inpaitment
management of alcohol drug interaction with BZDs
avoid
management of drug interaction between BZDs and clozapine
Avoid if possible
drug interaction between clozapine and BZDs
respiratory suppression
Common AEs of BZDs
CNS depression fatigue sedation psychomotor impairment dizziness weakness
BZDs effect on memory
anterograde amnesia
BZDs with the worst effects on amnesia
lorazepam
triazolam
midazolam
who is more likely to experience behavioral effects with BZDs
children
brain injuries
elderly
what behavioral effects are seen with BZDs
disinhibition
increased agitation
increased aggression
BZD pregnancy category
D
Possible outcomes of abrupt BZD d/c
Rebound
Relapse
Withdrawal
rebound definition
anxiety above pretreatment levels for a few days
relapse definition
anxiety back to pretreatment levels
common symptoms of BZD withdrawal
restlessness insomnia decreased concentration nausea decreased appetite heart palpitations weakness increased acuity to sound, smell, touch, pain, irritability
symptom of extreme cases of BZD withdrawal
seizures
factors that increase the likelihood of BZD dependence
high potency BZDs
use 6+ months
high dose use
how much should BZD dose be reduced per week
10-25% of total daily dose
Advantages of BZDs
work immediately
take PRN
cheap
no sexual dysfunction
disadvantages of using BZDs
risk of abuse and dependence
buspirone brand name
Buspar
buspar active metabolite
yes 1
buspirone elimination half life
2.6 hours
buspirone dose
5 mg TID or 7.5 mg BID ->
10 mg TID or 15 mg BID
buspirone dosage range
20-60 mg / day in divided doses
buspirone pregnancy cat
D
Common AEs of buspirone
dizziness
lightheadedness
nausea
HA
buspirone drug interactions
azole antifungals clarithromycin nefazodone erythromycin MAOI
buspirone interaction with azole antifungals and management
increased buspar levels
decrease dose of buspar to 2.5 mg QD
buspirone interaction with clarithromycin and management
increased buspirone levels
decrease buspar to 2.5 mgQD