Anxiolytics Flashcards
How is acute anxiety treated?
Benzodiazepines prn
How is chronic anxiety treated?
SSRI or SNRI, may take weeks for max effect so treat interim with BZD prn short term
What general information is important to know about Benzos?
- Controlled substance IV
- If chronic use taper slowly, abrupt D/C can be fatal
How do benzos work?
Bind to GABA receptors and enhance inhibitory effect on neurons
What actions are associated with benzodiazepines?
- Reduction of anxiety
- Impaired memory (anterograde amnesia)
- sedative and hypnotic actions
- Anticonvulsant
- Muscle relaxant
What patient population do Benzos have a huge caution/ do not use in?
Elderly (can accumulate due to long 1/2 life and low metabolism)
What benzos have a long 1/2 life? How long is their 1/2 life?
- Klonopin
- Valium
- Librium (ETOH abuse)
- 25-100 hour 1/2 life
What are the medium interval benzos and their 1/2 life?
- Lorazepam (Ativan)
- Temazepam (Restoril)
- 10-15 hours
What are the short half life Benzos? What is 1/2 life?
-Alprazolam (Xanax)
-Oxazepam (Serax)
<12 hour 1/2 life
What ADRs are associated with all types of BZDs?
- Drowsiness
- Confusion/ cognitive impairment (driving)
- Ataxia
Other than the elderly what other areas require caution with use of BZDs?
- Other CNS drugs ETOH/Opioids
- Glaucoma
- Hepatic dz
- Renal dz
What occurs in long term/ abrupt withdrawal from benzos?
- Seizures
- Agitation
- Restlessness
- Anxiety
- Confusion
What type of Benzos have the most severe w/drawal sx (and faster onset)?
Short term BZDs (Xanax, Serax)
What is important to remember about PK of Benzos?
- They are metabolized by the liver to active metabolites, must consider for clinical duration as well
- Major CYP inhibitors affect PK (3A4, 2c19)
Are BZDs good drugs to use in pregnant pts?
No they carry D or X rating and can be passed through breast milk to nursing baby
