anxiety management

Question 1

Treatment of GAD and panic disorder

Answer 1

CBT
SSRIs (first line - escitalopram)
other SSRI/SNRI
pre-gabalin 
benzodiazepine for severe (short term only)

Question 2

treatment of phobias

Answer 2

behavioural therapy - exposure
add CBT if necessary
SSRIs/SNRIs if necessary

Question 3

treatment of OCD

Answer 3

CBT and response prevention

SSRI/clomipramine (tricyclic)

Question 4

when are Bblockers used in treatment of anxiety

Answer 4

reduces somatic symptoms (palpitations, tremor, sweating)

Question 5

what can Bblockers make worse

Answer 5

cognitive anxiety

Question 6

what Bblocker is used in anxiety

Answer 6

propranolol

Question 7

examples of benzodiazepines

Answer 7

midazolam
lorazepam
diazepam
chlordiazepoxide

Question 8

how is lorazepam given

Answer 8

oral

Question 9

how is midazolam given

Answer 9

IV

Question 10

what effects do benzodiazepines have on the body

Answer 10

reduce anxiety ad aggression 
sedation 
muscle relaxant 
anticonvulsant 
anterograde amnesia

Question 11

action of benzodiazepines

Answer 11

increasing action of GABA (inhibitory neurotransmitter)

Question 12

apart from acute treatment of extreme anxiety, when else are benzodiazepines used

Answer 12

alcohol withdrwal
mania
delirium
rapid tranquilisation 
pre-med before surgery
status epilepticus

Question 13

what receptors do benzodiazepines work on

Answer 13

GABAa

Question 14

SE benzodiazepines

Answer 14

paradoxical aggression
anterograde amnesia 
impaired co-ordination
tolerance 
dependence (addiction)

Question 15

symptoms of rapid withdrawal of benzodiazepines

Answer 15

confusion 
toxic psychosis
convulsions
insomnia
anxiety
loss of appetite/weight loss
tremor/sweating
tinnitus

Question 16

why do we become tolerant to benzodiazepines

Answer 16

decreased response to GABA

Question 17

how to safely withdraw benzodiazepines

Answer 17

transfer patient to diazepam/chlordiazepoxide (taken at night)
reduce dose every 2-3 weeks in steps of 2-2.5 mg

Question 18

if begin to get withdrawal symptoms when decreasing, what do you do

Answer 18

maintain at that dose until symptoms improve

reduce dose slower

Question 19

what is pregabalin

Answer 19

Ca chanel blocker and GABA enhancer

Question 20

when is pregabalin used

Answer 20

if not responsive to other treatments

Question 21

action of buspirone

Answer 21

5HT receptor partial agonist 
presynaptic dopamine antagonist (D2, D3, D4)
a1 receptor agonist
SUPPRESSES 5HT 
STIMULATES NORADRENALINE AND DOPAMINE

Question 22

what happens if benzos used in pregnancy

Answer 22

cleft palate

Question 23

what happens if benzos used in breast feeding

Answer 23

floppy baby