Anxiety Medications Flashcards
GAD Excessive anxiety and worry occurring more
days than not > 6 months
GAD other criteria
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
GAD first choice
BZD
BZD should be used in combination with
anitdepressant
limit BZD trial to
1 - 4 weeks
relapse rate of BZD is what percentage
50 to 70% in first year
Use what type of BZD over wat other type
long acting over short acting
Buspirone benefits and draw backs
safer than BZD, but take a longer time to work
Side effect for venlafaxine
nausea
Somestimes when you start an ssri it might
increase anxiety, but this is temporary.
Kava kava associated with
fatal hepatoxicity
FDA warning
Valerian has a mild
sedative effects in animals
inconclusive results
no data long-term safety
BZD MOA
enhance the inhibitory
neurotransmitter systems that utilize GABA.
Indications for BZD
Anxiety • Panic Attacks • Bridge to therapy – Sedation/hypnotic – Anticonvulsants – Substance abuse withdrawal – Depression adjunct
Longer half life BZD drugs
diazepam, clonazepam
longer half life BZD are used
daily to 2 - 4 times daily
longer half life BZD are and show
Less severe withdrawal*
More daytime sedation
Shorter half life drugs BZD
lorazepam, alprzolam
short half life bzd dosing
three times daily dosing
drawbacks to short half life bzd
– 3 times daily dosing*
– More rebound anxiety
– Greater dependence potential
BZD side effects
- Sedation
- Dizziness
- Disinhibition
- Respiratory distress
- Mild cognitive impairment
- Anterograde amnesia
- Tolerance, dependence, withdrawal
BZD is usually restricted to
two to four week use due to tolerance
BZD is a schedule
4 drug
BZD has what kind of effects
hypnotic and anxiolytic
increasing dose of BZD is required
to prevent withdrawal syndrome
With BZD use you will reach a
plateau when no longer efeicve and see increasing symptoms
BZD withdrawal syndrome symptoms
Anxiety Irritability Insomnia Fatigue Muscle twitching Tremor, shakiness Sweating Dizziness Headache Nausea; anorexia Depression Abnormal sensation of movement Concentration difficulties Depersonalization Increased sensory perception
The key to limiting withdrawal symptoms from BZD
taper the medication clowling. It typically takes months, achiveing rougly a 10 percent dose reduction per week.
other methods to limit BCD rebound anxiety and withdral
Convert short‐acting benzodiazepines to agent with
longer‐acting elimination elimination half‐life prior to tapering tapering - diazepam, clonazepam*
Treat the patient with an antidepressant (6‐8 weeks)
before attempting to taper
Commence short‐term cognitive behavioral therapy
(eg. several weeks to six months)
BZD long term therapy you should monitor
• Long term therapy
– CBC
– LFTs
BZD can give a
false preganancy test
BZD drug interactions
– Numerous
– Cimetidine, erythromycin, fluoxetine, metoprolol,
propranolol, oral contaceptive
Long-term acting as adjunct in depression
use a low dose
Shorter-acting bzd in management of panic disorder dosing
– 2‐3 times per day for 3 days*
– Start at lowest dose
Tapering guidelines
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
BZD drug interactions
– Cimetidine – CNS depressants (alcohol, antihistamines, TCAs) – Erythromycin – Propranolol, metoprolol – Oral contraceptive
BZD pedicatrics
– Few trials
– Reported: hallucinations, incoordination, insomnia, light
sensitivity, fear
– Not recommended recommended < 18 years
Elderly BZD
Increased risk of falls, CNS effects
– Lipophilic
– Decreased metabolism
BZD preganancy and lactation
not recommended - cleft pallet
BZD like drugs NAMES
– Eszopiclone (Lunesta)
– Zaleplon (Sonata)
– Zolpidem (Ambien)
Indications for BZD liked drugs
– Insomnia
– Weak muscle relaxant
– Weak anti‐seizure effects
Dosing BZD like drugs
- Start low, titrate up
- HS dosing
- Recommend short term treatment
- 7‐14 days
- Taper off
Buspirone indicatiosn
– GAD, Social phobia, adjunct in OCD and PTSD; not
effective for immediate use
Buspirone cant take
4 to 12 weeks to take effect
Buspirone facts
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
