anxiety management Flashcards
Treatment of GAD and panic disorder
CBT SSRIs (first line - escitalopram) other SSRI/SNRI pre-gabalin benzodiazepine for severe (short term only)
treatment of phobias
behavioural therapy - exposure
add CBT if necessary
SSRIs/SNRIs if necessary
treatment of OCD
CBT and response prevention
SSRI/clomipramine (tricyclic)
when are Bblockers used in treatment of anxiety
reduces somatic symptoms (palpitations, tremor, sweating)
what can Bblockers make worse
cognitive anxiety
what Bblocker is used in anxiety
propranolol
examples of benzodiazepines
midazolam
lorazepam
diazepam
chlordiazepoxide
how is lorazepam given
oral
how is midazolam given
IV
what effects do benzodiazepines have on the body
reduce anxiety ad aggression sedation muscle relaxant anticonvulsant anterograde amnesia
action of benzodiazepines
increasing action of GABA (inhibitory neurotransmitter)
apart from acute treatment of extreme anxiety, when else are benzodiazepines used
alcohol withdrwal mania delirium rapid tranquilisation pre-med before surgery status epilepticus
what receptors do benzodiazepines work on
GABAa
SE benzodiazepines
paradoxical aggression anterograde amnesia impaired co-ordination tolerance dependence (addiction)
symptoms of rapid withdrawal of benzodiazepines
confusion toxic psychosis convulsions insomnia anxiety loss of appetite/weight loss tremor/sweating tinnitus
why do we become tolerant to benzodiazepines
decreased response to GABA
how to safely withdraw benzodiazepines
transfer patient to diazepam/chlordiazepoxide (taken at night)
reduce dose every 2-3 weeks in steps of 2-2.5 mg
if begin to get withdrawal symptoms when decreasing, what do you do
maintain at that dose until symptoms improve
reduce dose slower
what is pregabalin
Ca chanel blocker and GABA enhancer
when is pregabalin used
if not responsive to other treatments
action of buspirone
5HT receptor partial agonist presynaptic dopamine antagonist (D2, D3, D4) a1 receptor agonist SUPPRESSES 5HT STIMULATES NORADRENALINE AND DOPAMINE
what happens if benzos used in pregnancy
cleft palate
what happens if benzos used in breast feeding
floppy baby
