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Nurs 5225 Psychopharmacology APRN/MHN > Anxiolytics and Hypnotics > Flashcards

Anxiolytics and Hypnotics Flashcards

1
Q

Pharmacological Approaches to Anxiety

A

SSRI
SNRI
Benzodiazepines
Off-Lable/Other Agents

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2
Q

SSRI medications for anxiety

A 
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
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3
Q

When using SSRI remember to

A

start low, go slow, and go all the way.

Can be activating. May need higher dosing to support and acheive antianxiety effects.

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4
Q

First line treatment is

A

SSRI

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5
Q

How to chose an SSRI

A

side effect profile, durg-drug interactions, insurance, patient preference.

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6
Q

SNRI medications for anxiety

A 
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Vilazodone (Viibryd)
Vortioxetine (Trintellix)
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7
Q

Benzodiazepine medications for anxiety

A 
GABA receptor agonists
Schedule IV Controlled Substances
Contraindications
Adverse Effects
Dependence and Misuse
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8
Q

Benzo Guidelines

A

Start with long acting medications.
Use short-acting medications for as-nneded occasional anxiety
start SSRI/SNRI with benzodiazepine for 1st two weeks
consider other non-benzodiazepine medications

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9
Q

Short acting benzo

A

Midazolam (Versed)

Triazolam (Halcion)

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10
Q

Intermediate-acting benzo

A

Alprazolam (Xanax)
Lorazepam (Ativan)
Temazepam (Restoril)

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11
Q

Long-Acting benzo

A

Diazepam (Valium)

Clonazepam (Klonopin)

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12
Q

85% of abuse occure in

A

people with substance use history who take benzos

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13
Q

Temazepam is typically used for

A

sleep issues

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14
Q

Halcion (triazolam) is sometime used for

A

sleep

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15
Q

Xanax is FDA approved for

A

panic and GAD

off lable for mania psycosis and catatonia

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16
Q

Ativan is FDA approved for

A

longer half life than xanax

GAD and epilepsy

17
Q

Valium is FDA approved for

A

sleep, anxiety, ETOH withdrawal, seizures, preop

18
Q

Nice thing about ativan

A

better use with other medications.

19
Q

Klonipin

A

seizures and panic diosrders

off lable, acute episode of anxity or insomnia related to bipoloar

less rebound anxiety due to long acting nature

20
Q

Assess for misuse

A 
signs of diversion of overuse
pill counts 
urine test
PMP database
Controlled subtance agreement
non-benzo medications
21
Q

Benzodiazepine medication taper

A

Benzodiazepine Dosage Equivalents

Withdrawal Symptoms
Acute vs Long Term

Adjunctive Medications
Taper Schedule

Gradual and Rapid
Changing to long-acting benzodiazepine

Non-pharmacological Interventions

22
Q

Acute withdrawl s/s

A

restlessness, agitation, tremors, shaking, diziness, SOB and sweating, heart palpitations, poor sleep, seizures, changes in appeite, bowel and bladder concerns, deleium

23
Q

Long term witdrawl

A

worsening anxiety, greater more difficult managment of anxiety, mood changes, depression, rebound insomnia

24
Q

drugs that can support benzo taper

A 
Clonidone
baclofen
gababentin
carbamazapine
trazadone 
mitrazapine 
propanolol 
hydroxazine 
buspar
25
Q

You do not want to taper in the

A

outpatient setting

26
Q

do not want to adust dose more than

A

25% of total daily dose per week

27
Q

Other agents to treat anxiety

A 
Buspirone
Gabapentin
Quetiapine
Hydroxyzine
Prazosin
Propanolol
Pregabalin
28
Q

Buspar

A

nice side effect, generic, may be used to as an adjunct. Can be used two to three times a day. If not working, check how they are using it.

29
Q

Gabapentin

A

anitcunvulsant. Used off lable for anxiety, pain, nightmares

30
Q

Quetiapine

A

off lable for anxiety, panic, sleep, PTSD, adjuct for depression. Has metabolic problems at lower doses. Less then say a zyprexa

31
Q

Hydroxyzine

A

off lable for anxiety and sleep. Antichologeric properties so be carful in older adults

32
Q

prasosin

A

off lable for nightmares, ptsd

33
Q

propranolol

A

off lable for anxiety. nice for someone who has somatic symptoms

34
Q

Pregabalin or lyrica

A

used to treat neuropatic pain. off lable for GAD but not showing good results.

35
Q

Non-pharmacological approach

A 
motivational intervering
CBT
Exercise
Sleep
reduction of stimulatn use

Nurs 5225 Psychopharmacology APRN/MHN (7 decks)

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