NERVOUS SYSTEM - ANXIETY

Question 1

What is anxiety?

Answer 1

Normal emotion, can be severe, disabling + chronic

Question 2

What are 5 symptoms of anxiety?

Answer 2

Worry

Fear

Restlessness

Irritability

Difficulty concentrating

Question 3

List 6 physical symptoms?

Answer 3

Palpitations

Tremors

Muscle tension

Sweating

SOB

Insomnia

Question 4

What are the 2 main classes of anxiolytic drugs?

Answer 4

Benzodiazepines

Beta blocker

Question 5

What are 2 drugs used for chronic anxiety?

Answer 5

SSRI

Propranolol - physical symptoms

Question 6

List 4 short acting benzodiazepines?

Answer 6

Triazolam
Midazolam
Oxazepam
Lorazepam

Question 7

What 3 benzodiazepines are also used in insomnia treatment?

Answer 7

Diazepam

Oxazepam

Lorazepam

Question 8

What are 5 long acting benzodiazepines?

Answer 8

Chlordiazepoxide

Diazepam

Clorazepate

Flurazepam

Clobazam

Question 9

What is the risk of long acting benzos in elderly patients?

Answer 9

Can induce hepatic coma

Question 10

What type of benzos is best used in elderly patients?

Answer 10

Short acting benzos

e.g. lorazepam, oxazepam, midazolam

Question 11

What schedule drug is benzodiazepines?

Answer 11

Sch 4 part 1

Question 12

What 4 drug classes can be used to treat anxiety?

Answer 12

5HT1a alpha = buspirone

Antidepressant

Anti-epileptic

Anti-psychotic

Question 13

What is MOA of benzodiazepines?

Answer 13

Increasing binding of GABA at GABAa receptors.

Causes CNS depressant effects

Question 14

What is clobazam used in also?

Answer 14

Epilepsy

Question 15

What is chlordiazepoxide used for?

Answer 15

Acute alcohol withdrawal

Question 16

What 2 benzodiazepines can be used in dental procedures?

Answer 16

Temazepam **

Diazepam

Question 17

Which 5-ht1A agonist is used for anxiety and does NOT cause dependancy?

Answer 17

Buspirone

Question 18

What is indication of benzos?

Answer 18

Short term use for anxiety

Question 19

How long is benzos used for in anxiety?

Answer 19

Short term (2-4 weeks)

Question 20

What dose of benzos to give in elderly?

Answer 20

Half dose

Question 21

When to give a half dose of benzos?

Answer 21

Elderly

Liver impairment

Question 22

Why should benzos be typically avoided in elderly?

Answer 22

Can cause falls/sedation/ confusion

Question 23

What is a paradoxical effect ?

Answer 23

increase in hostility, aggression and anxiety

Question 24

What is an antidote for benzodiazepine overdose?

Answer 24

Flumazenil

Question 25

Can you drive whilst taking benzodiazepines?

Answer 25

Avoid IF feeling drowsy

Question 26

What 6 benzodiazepines have a legal driving limit? (COLD FT)

Answer 26

Clonazepam Oxazepam Lorazepam Diazepam Flunitrazepam Temazepam

Question 27

What effect is seen in patients taking benzodiazepines?

Answer 27

paradoxical effect

Question 28

What warning label is on benzos?

Answer 28

This med makes you sleepy. If you feel sleepy, do not drive or use machinery. Do not drink alcohol

Question 29

What condition is a caution as benzos can cause muscle weakness?

Answer 29

Myasthenia gravis

Question 30

What are the 5 SEs of Benzos ? CRAMPS

Answer 30

CNS depression Respiratory depression Ataxia Muscle weakness Paradoxical effect Sedation

Question 31

What is a mhra warning for benzos related to respiratory depression?

Answer 31

Benzos + opiod can cause CNS depressant effects. Monitor signs of resp depression.

Question 32

How to monitor respiratory depression?

Answer 32

Slow/ shallow breathing Sedation Blue lips

Question 33

What is a risk of using benzodiazepines?

Answer 33

Dependence + tolerance

Question 34

How to avoid dependence or tolerance?

Answer 34

Avoid prolonged use + abrupt withdrawal

Question 35

What does alcohol + benzos do?

Answer 35

Increase CNS depression effects such as sedation

Question 36

What 6 drug classes interact with benzos to cause sedation?

Answer 36

Alcohol Opioids Antihistamines Anti-psychotics, Barbiturate Z-drug

Question 37

What are the 5 symptoms of benzodiazepine withdrawal?

Answer 37

Anxiety Sweating Weight Loss Tremors Loss of appetite

Question 38

What 3 steps done to deal with withdrawal of long-term benzos?

Answer 38

1) convert benzo meds into equivalent diazepam ON dose 2) Then reduce dose of diazepam by 1 to 2 mg every 2-4 weeks (wait for all symptoms to go) 3) reduce diazepam dose by 0.5mg near end.

Question 39

What 2 benzos are occasionally given IV for panic attacks?

Answer 39

Lorazepam Diazepam

Question 40

What 3 benzos act for a shorter time and have no hangover effect?

Answer 40

Loprazolam, lormetazepam, and temazepam

Question 41

When can benzodiazepine withdrawal syndrome may develop at any time after stopping long acting?

Answer 41

3 weeks

Question 42

When can benzodiazepine withdrawal syndrome may develop at any time after stopping SHORT acting?

Answer 42

occur within a day

Question 43

What are 6 Symptoms of benzo withdrawal syndrome?

Answer 43

insomnia, anxiety, loss of appetite + body-weight, tremor, perspiration, tinnitus, and perceptual disturbances

Question 44

How long does Withdrawal symptoms for long-term users take to RESOLVE?

Answer 44

6-18 months