CNS anxiety Flashcards
acute treatment for anxiety
benzos:
Lorazepam/Diazepam- short term use, lowest dose
chronic treatment for anxiety
SSRIs- sertraline, citalopram, excitalopram, fluoxetine
Propranolol- alleviates physical symptoms only not mental(eg tremors, fast HR)
benzodiazepines can induce what?
Hepatic coma, especially long-acting
so, treat w lowest dose for shortest period
2 classes of benzodiazepines, short and long acting.
give examples of LONG acting
DC^2
Diazepam
Chlordiazepoxide (can be used fortx of alcohol withdrawal)
Clobazam
2 classes of benzodiazepines, short and long acting.
give examples of SHORT acting
Lorazepam (epilepsy) quick to act
Oxazepam
SA benzos preferred in hepatic impairment/elderly BUT… whats a downside
greater risk of withdrawal symptoms (max. 2-4 weeks use)
benzos can cause paradoxical effects
i.e. have opposite effect of what were trying to treat.
give examples
aggression, hostility, talkative, anxious, excited, etc
with benzos, SEDATION is increased with use of what?
alcohol
CNS depressants
CYP enz inhibitors
- avoided concomitant use
some benzos have a legal driving limit
i.e. avoid drivnig if feeling drowsy.
which ones? (COLD FT)
Clonazepam
Oxazepam
Lorazepam
Diazepam
Flunitrazepam
Temazepam
benzos overdose treated by which drug
flumazenil
((can prevent need for ventilation (avoid in OD TCA mixed)
Activated charcoal can be given within 1 hour of ingesting a significant quantity of benzodiazepine- if patient awake+protected airway
))
BENZODIAZEPINES- WITHDRAWAL
Withdrawal symptoms?
anxiety/sweating/weight loss/tremors/loss of appetite
3 steps in withdrawal of benzos
1) Convert all meds to diazepam x1 ON
2) Reduce by 1-2mg (1/10th on larger doses) every 2-4 weeks
only further withdraw if patient has overcome withdrawal symptoms. wait
3) Reduce further (0.5mg near the end)
