Anxiolytics and Hypnotics

Question 1

Pharmacological Approaches to Anxiety

Answer 1

SSRI
SNRI
Benzodiazepines
Off-Lable/Other Agents

Question 2

SSRI medications for anxiety

Answer 2

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

Question 3

When using SSRI remember to

Answer 3

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

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

Question 4

First line treatment is

Answer 4

SSRI

Question 5

How to chose an SSRI

Answer 5

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

Question 6

SNRI medications for anxiety

Answer 6

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

Question 7

Benzodiazepine medications for anxiety

Answer 7

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

Question 8

Benzo Guidelines

Answer 8

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

Question 9

Short acting benzo

Answer 9

Midazolam (Versed)

Triazolam (Halcion)

Question 10

Intermediate-acting benzo

Answer 10

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

Question 11

Long-Acting benzo

Answer 11

Diazepam (Valium)

Clonazepam (Klonopin)

Question 12

85% of abuse occure in

Answer 12

people with substance use history who take benzos

Question 13

Temazepam is typically used for

Answer 13

sleep issues

Question 14

Halcion (triazolam) is sometime used for

Answer 14

sleep

Question 15

Xanax is FDA approved for

Answer 15

panic and GAD

off lable for mania psycosis and catatonia

Question 16

Ativan is FDA approved for

Answer 16

longer half life than xanax

GAD and epilepsy

Question 17

Valium is FDA approved for

Answer 17

sleep, anxiety, ETOH withdrawal, seizures, preop

Question 18

Nice thing about ativan

Answer 18

better use with other medications.

Question 19

Klonipin

Answer 19

seizures and panic diosrders

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

less rebound anxiety due to long acting nature

Question 20

Assess for misuse

Answer 20

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

Question 21

Benzodiazepine medication taper

Answer 21

Benzodiazepine Dosage Equivalents

Withdrawal Symptoms
Acute vs Long Term

Adjunctive Medications
Taper Schedule

Gradual and Rapid
Changing to long-acting benzodiazepine

Non-pharmacological Interventions

Question 22

Acute withdrawl s/s

Answer 22

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

Question 23

Long term witdrawl

Answer 23

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

Question 24

drugs that can support benzo taper

Answer 24

Clonidone
baclofen
gababentin
carbamazapine
trazadone 
mitrazapine 
propanolol 
hydroxazine 
buspar

Question 25

You do not want to taper in the

Answer 25

outpatient setting

Question 26

do not want to adust dose more than

Answer 26

25% of total daily dose per week

Question 27

Other agents to treat anxiety

Answer 27

``` Buspirone Gabapentin Quetiapine Hydroxyzine Prazosin Propanolol Pregabalin ```

Question 28

Buspar

Answer 28

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.

Question 29

Gabapentin

Answer 29

anitcunvulsant. Used off lable for anxiety, pain, nightmares

Question 30

Quetiapine

Answer 30

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

Question 31

Hydroxyzine

Answer 31

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

Question 32

prasosin

Answer 32

off lable for nightmares, ptsd

Question 33

propranolol

Answer 33

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

Question 34

Pregabalin or lyrica

Answer 34

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

Question 35

Non-pharmacological approach

Answer 35

``` motivational intervering CBT Exercise Sleep reduction of stimulatn use ```