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Nurs 5229 Clinical Pharmacotherapeutics > Anxiety Medications > Flashcards

Anxiety Medications Flashcards

1
Q

GAD Excessive anxiety and worry occurring more

A

days than not > 6 months

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2
Q

GAD other criteria

A

Difficulty in controlling the worry
• Anxiety and worry associ d ate wi ht 3 of the
following symptoms:
– Restlessness, fatigue, decreased concentration,
irritability, muscle tension, sleep

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3
Q

GAD first choice

A

BZD

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4
Q

BZD should be used in combination with

A

anitdepressant

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5
Q

limit BZD trial to

A

1 - 4 weeks

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6
Q

relapse rate of BZD is what percentage

A

50 to 70% in first year

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7
Q

Use what type of BZD over wat other type

A

long acting over short acting

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8
Q

Buspirone benefits and draw backs

A

safer than BZD, but take a longer time to work

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9
Q

Side effect for venlafaxine

A

nausea

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10
Q

Somestimes when you start an ssri it might

A

increase anxiety, but this is temporary.

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11
Q

Kava kava associated with

A

fatal hepatoxicity

FDA warning

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12
Q

Valerian has a mild

A

sedative effects in animals
inconclusive results
no data long-term safety

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13
Q

BZD MOA

A

enhance the inhibitory

neurotransmitter systems that utilize GABA.

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14
Q

Indications for BZD

A 
Anxiety
• Panic Attacks
• Bridge to therapy
– Sedation/hypnotic
– Anticonvulsants
– Substance abuse withdrawal
– Depression adjunct
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15
Q

Longer half life BZD drugs

A

diazepam, clonazepam

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16
Q

longer half life BZD are used

A

daily to 2 - 4 times daily

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17
Q

longer half life BZD are and show

A

Less severe withdrawal*

More daytime sedation

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18
Q

Shorter half life drugs BZD

A

lorazepam, alprzolam

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19
Q

short half life bzd dosing

A

three times daily dosing

20
Q

drawbacks to short half life bzd

A

– 3 times daily dosing*
– More rebound anxiety
– Greater dependence potential

21
Q

BZD side effects

A
  • Sedation
  • Dizziness
  • Disinhibition
  • Respiratory distress
  • Mild cognitive impairment
  • Anterograde amnesia
  • Tolerance, dependence, withdrawal
22
Q

BZD is usually restricted to

A

two to four week use due to tolerance

23
Q

BZD is a schedule

A

4 drug

24
Q

BZD has what kind of effects

A

hypnotic and anxiolytic

25
Q

increasing dose of BZD is required

A

to prevent withdrawal syndrome

26
Q

With BZD use you will reach a

A

plateau when no longer efeicve and see increasing symptoms

27
Q

BZD withdrawal syndrome symptoms

A 
ƒ Anxiety
ƒ Irritability
ƒ Insomnia
ƒ Fatigue
ƒ Muscle twitching
ƒ Tremor, shakiness
ƒ Sweating
ƒ Dizziness
ƒ Headache
ƒ Nausea; anorexia
ƒ Depression
ƒ Abnormal sensation of
movement
ƒ Concentration
difficulties
ƒ Depersonalization
ƒ Increased sensory
perception
28
Q

The key to limiting withdrawal symptoms from BZD

A

taper the medication clowling. It typically takes months, achiveing rougly a 10 percent dose reduction per week.

29
Q

other methods to limit BCD rebound anxiety and withdral

A

ƒ Convert short‐acting benzodiazepines to agent with
longer‐acting elimination elimination half‐life prior to tapering tapering - diazepam, clonazepam*

ƒ Treat the patient with an antidepressant (6‐8 weeks)
before attempting to taper

ƒ Commence short‐term cognitive behavioral therapy
(eg. several weeks to six months)

30
Q

BZD long term therapy you should monitor

A

• Long term therapy
– CBC
– LFTs

31
Q

BZD can give a

A

false preganancy test

32
Q

BZD drug interactions

A

– Numerous
– Cimetidine, erythromycin, fluoxetine, metoprolol,
propranolol, oral contaceptive

33
Q

Long-term acting as adjunct in depression

A

use a low dose

34
Q

Shorter-acting bzd in management of panic disorder dosing

A

– 2‐3 times per day for 3 days*

– Start at lowest dose

35
Q

Tapering guidelines

A

Slow!! Months
• Switch from short‐acting to long‐acting
(Diazepam)
• Monitor symptoms
• How to withdraw from Benzodiazepines
• http://www.benzo.org.uk/manual/bzcha02.ht
m

36
Q

BZD drug interactions

A 
– Cimetidine
– CNS depressants (alcohol, antihistamines, TCAs)
– Erythromycin
– Propranolol, metoprolol
– Oral contraceptive
37
Q

BZD pedicatrics

A

– Few trials
– Reported: hallucinations, incoordination, insomnia, light
sensitivity, fear
– Not recommended recommended < 18 years

38
Q

Elderly BZD

A

Increased risk of falls, CNS effects
– Lipophilic
– Decreased metabolism

39
Q

BZD preganancy and lactation

A

not recommended - cleft pallet

40
Q

BZD like drugs NAMES

A

– Eszopiclone (Lunesta)
– Zaleplon (Sonata)
– Zolpidem (Ambien)

41
Q

Indications for BZD liked drugs

A

– Insomnia
– Weak muscle relaxant
– Weak anti‐seizure effects

42
Q

Dosing BZD like drugs

A
  • Start low, titrate up
  • HS dosing
  • Recommend short term treatment
  • 7‐14 days
  • Taper off
43
Q

Buspirone indicatiosn

A

– GAD, Social phobia, adjunct in OCD and PTSD; not

effective for immediate use

44
Q

Buspirone cant take

A

4 to 12 weeks to take effect

45
Q

Buspirone facts

A

Not a central central nervous nervous system depressant depressant
• Has no abuse potential
• Does not intensify the effects of central nervous
system depressants
• Anxiolytic effects develop slowly

Nurs 5229 Clinical Pharmacotherapeutics (78 decks)

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