NERVOUS SYSTEM - ANXIETY Flashcards
What is anxiety?
Normal emotion, can be severe, disabling + chronic
What are 5 symptoms of anxiety?
Worry
Fear
Restlessness
Irritability
Difficulty concentrating
List 6 physical symptoms?
Palpitations
Tremors
Muscle tension
Sweating
SOB
Insomnia
What are the 2 main classes of anxiolytic drugs?
Benzodiazepines
Beta blocker
What are 2 drugs used for chronic anxiety?
SSRI
Propranolol - physical symptoms
List 4 short acting benzodiazepines?
Triazolam
Midazolam
Oxazepam
Lorazepam
What 3 benzodiazepines are also used in insomnia treatment?
Diazepam
Oxazepam
Lorazepam
What are 5 long acting benzodiazepines?
Chlordiazepoxide
Diazepam
Clorazepate
Flurazepam
Clobazam
What is the risk of long acting benzos in elderly patients?
Can induce hepatic coma
What type of benzos is best used in elderly patients?
Short acting benzos
e.g. lorazepam, oxazepam, midazolam
What schedule drug is benzodiazepines?
Sch 4 part 1
What 4 drug classes can be used to treat anxiety?
5HT1a alpha = buspirone
Antidepressant
Anti-epileptic
Anti-psychotic
What is MOA of benzodiazepines?
Increasing binding of GABA at GABAa receptors.
Causes CNS depressant effects
What is clobazam used in also?
Epilepsy
What is chlordiazepoxide used for?
Acute alcohol withdrawal
What 2 benzodiazepines can be used in dental procedures?
Temazepam **
Diazepam
Which 5-ht1A agonist is used for anxiety and does NOT cause dependancy?
Buspirone
What is indication of benzos?
Short term use for anxiety
How long is benzos used for in anxiety?
Short term (2-4 weeks)
What dose of benzos to give in elderly?
Half dose
When to give a half dose of benzos?
Elderly
Liver impairment
Why should benzos be typically avoided in elderly?
Can cause falls/sedation/ confusion
What is a paradoxical effect ?
increase in hostility, aggression and anxiety
What is an antidote for benzodiazepine overdose?
Flumazenil
Can you drive whilst taking benzodiazepines?
Avoid IF feeling drowsy
What 6 benzodiazepines have a legal driving limit? (COLD FT)
Clonazepam
Oxazepam
Lorazepam
Diazepam
Flunitrazepam
Temazepam
What effect is seen in patients taking benzodiazepines?
paradoxical effect
What warning label is on benzos?
This med makes you sleepy. If you feel sleepy, do not drive or use machinery. Do not drink alcohol
What condition is a caution as benzos can cause muscle weakness?
Myasthenia gravis
What are the 5 SEs of Benzos ? CRAMPS
CNS depression
Respiratory depression
Ataxia
Muscle weakness
Paradoxical effect
Sedation
What is a mhra warning for benzos related to respiratory depression?
Benzos + opiod can cause CNS depressant effects.
Monitor signs of resp depression.
How to monitor respiratory depression?
Slow/ shallow breathing
Sedation
Blue lips
What is a risk of using benzodiazepines?
Dependence + tolerance
How to avoid dependence or tolerance?
Avoid prolonged use + abrupt withdrawal
What does alcohol + benzos do?
Increase CNS depression effects such as sedation
What 6 drug classes interact with benzos to cause sedation?
Alcohol
Opioids
Antihistamines
Anti-psychotics,
Barbiturate
Z-drug
What are the 5 symptoms of benzodiazepine withdrawal?
Anxiety
Sweating
Weight Loss
Tremors
Loss of appetite
What 3 steps done to deal with withdrawal of long-term benzos?
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.
What 2 benzos are occasionally given IV for panic attacks?
Lorazepam
Diazepam
What 3 benzos act for a shorter time and have no hangover effect?
Loprazolam, lormetazepam, and temazepam
When can benzodiazepine withdrawal syndrome may develop at any time after stopping long acting?
3 weeks
When can benzodiazepine withdrawal syndrome may develop at any time after stopping SHORT acting?
occur within a day
What are 6 Symptoms of benzo withdrawal syndrome?
insomnia, anxiety, loss of appetite + body-weight, tremor, perspiration, tinnitus, and perceptual disturbances
How long does Withdrawal symptoms for long-term users take to RESOLVE?
6-18 months
