Psychiatric Conditions: Anxiety Disorders Flashcards
SSRIs and SNRIs for anxiety, 1st line
Escitalopram = Lexapro
Fluoxetine = Prozac
Sertraline = Zoloft
Paroxetine = Paxil
Duloxetine = Cymbalta
Venlafaxine XR = Effexor
usually start 1/2 dose depression, titrate slowly and can take up to 4 wks for noticable effect
2nd line drugs for anxiety
Buspirone = 2-4wks for effect
TCA (Amitriptyline/Nortriptyline) = not FDA approved for anxiety
Hydroxyzine = sedating, not recommended for long term use
Pregabalin/Gabapentin = not approved but useful if anxiety + neuropathic pain
Propranolol (Inderal LA) for anixety
not FDA approved, but can be useful for stage fright or performance anxiety
usually 1hr prior to event
Buspirone Contraindications
no MAOi within 14 days, linezolid, IV methylene blue
Buspirone warnings
Risk of serotonin syndrome alone or in combo with other serotonergic drugs
Benzodiazepines
provide fast relief of symptoms, useful for short term txm of acute anxiety
should only be used for 1-2wks due to risk of dependence, taper if want to stop after longer periods > 10days
L-O-T drugs for elderly
Lorazepam = anxiety
Oxazepam = anxiety
Temazepam = insomnia
Common Benzodiazepines
Alprazolam = Xanax
Clonazepam = Klonopin
Diazepam = Valium
Lorazepam = Ativan
Benzodiazepine boxed warnings
use with opioids can inc sedation, respiratory depression, coma and death
risk for abuse, misuse and addiction
continued use can lead to physical dependence
Benzodiazepine contraindications
acute narrow angle glaucoma
sleep apnea
severe liver disease
Benzodiazepine warnings
CNS depression
anterograde amnesia
potential for abuse
safety risks in pts > 65 yrs old
pregnancy, crosses placenta
Benzodiazepine side effects
Somnolence
dizziness
ataxia
weakness
lightheadeness
Benzodiazepine antidote
flumazenil
