Anxiolytics

Question 1

Dependence of benzodiazepines

Answer 1

• The drug induces a rewarding experience • Drug taking becomes compulsive
• Psychological dependence
• Physical dependence
• Genetic factors

Question 2

Tolerance

Answer 2

is a physiological reaction (neuroadaption) characterized by a decrease in the effects of a drug with chronic administration.

Question 3

Withdrawal

Answer 3

• A result of physical dependence
• Increased anxiety, onset / exacerbation of depression
• Disturbed sleep
• Pain, stiffness , muscular aches
• Convulsions
• Can occur after relatively short courses of treatment (4 weeks)

Question 4

Abuse (DSM V Substance Use Disorder)

Answer 4

• Usually part of polydrug misuse
• Enhances “highs”
• Attenuates “crashes”
• In part iatrogenically driven

Question 5

Management of acute alcohol withdrawal

Answer 5

• Acute admissions to hospital
• Supply of alcohol interrupted
• Index of suspicion
• Alcohol history
• Severity of alcohol dependence questionnaire
• Assessment of withdrawal symptoms Chlordiazepoxide 1-2 week reducing regime

Question 6

CAGE questionnaire

Answer 6

• Have you ever felt you should Cut down your drinking?
• Have you ever been Annoyed by other people criticizing your
drinking?
• Have you ever felt Guilty about drinking?
• Have you ever taken a drink in the morning to steady your nerves or ease a hangover (Eye-opener)?

Question 7

Symptoms of alcohol withdrawal

Answer 7

May start 8 hours after drop in alcohol levels (peak day 2) Insomnia / anxiety/ restlessness/ agitation Tremor
Nausea & vomiting
Sweating
Palpitations
Hallucinations auditory / visual/tactile Seizures

Question 8

Investigations suggestive of chronic alcohol consumption

Answer 8

• Raised MCV
• Pancytopenia (result of alcohol induced bone marrow suppression
• Folate deficiency
• Prolonged prothrombin time

Question 9

Management of insomnia

Answer 9

• Difficulty getting off to sleep or waking up?
• Assessment? Pain/ breathlessness
• Good sleep hygiene
• Hypnotics reserved for the acutely distressed
• Caution in the elderly • Confusion
• Falls
• Slower metabolism

Question 10

What is sleep hygiene?

Answer 10

Sleep hygiene aims to make people more aware of behavioural, environmental & temporal factors that may be detrimental or beneficial to sleep

Question 11

Good Sleep hygiene

Answer 11

• Establish a regular pattern of going to bed & getting up
• Get regular exercise preferably in the morning but not within 4 hours of going to bed
• Keep your bedroom cool, dark & quiet
• Don’t have caffeine, alcohol or smoke within 6 hours
of bedtime
• Avoid screen time for at least 30mins before bed
• Avoid naps during the day

Question 12

Insomnia drug treatment

Answer 12

• Short acting benzo or z-drug
• Lowest effective dose for shortest time
• Inform patient no repeat prescriptions & explain why

Question 13

Anticipatory care plan

Answer 13

• Benzodiazepines often used in the last days or weeks of life • Management of anxiety
• Massive terminal haemorrhage
• Agitated delirium
• Breathlessness or respiratory distress (alongside opioid) • Midazolam is usually drug of choice

Question 14

Management of prolonged seizures (yes

Answer 14

• Protect the patient from injury
• Provide oxygen if available
• Consider / exclude hypoglycaemia
• Seizures lasting longer than 5 minutes intravenous lorazepam
• Intravenous access not available consider rectal diazepam or intranasal / buccal midazolam

Question 15

Law on driving (March 2015)

Answer 15

• This law states that it is an offence to drive with certain drugs above specified levels in the body, whether your driving is impaired or not
• If you are taking these medicines as directed and your driving is not impaired, then you are not breaking the law
• Benzos, opioids, amphetamines