Benzodiazapine (BZD) drug lists
- Alprazolam/Xanax
- Clonazepam/Klonopin
- Diazepam/Valium
- Lorazepam/Ativan
alprazolam
xanax
clonazepam
klonopin
diazepam
valium
lorazepam
ativan
BZD mechanisms
enhance GABA neurotransmission
long acting BZDs
clonazepam
diazepa
short acting BZDs
alprazolam
lorazepam
Efficacy of BZDs
- quick onset
- anxiolytic
- hypnotic
- muscle relaxation
- anticonvulsant (DOC for epilepsy) **
- amnesic
BZD side effects
tolerance/dependence (difficult to taper, caution in patients with substance abuse, potential for w/d)
CNS depression
BZD in elderly
use BZD with little renal clearance
LOTs: lorazepam, oxazepam, temazapam
BBW of BZDs
concomitant use of bends and opioids may result in death, coma, respiratory depression
BZDs schedule
IV controlled
limited to 5 refills/6 month
Buspirone
Buspar
mechanism unknown
use for those w/SA issues (not dependent)
drawback: long onset, TID dosing due to short half life
Pregabalin
lyrica
gabapentin
neurontin
Pregabalin/gabapentin
mechanism
NOT synthetic GABA
instead- inhibits glutamate release
glutamate antagonist
controlled level: Lyrica
CV substance
control level: gabapentin
neurotin
CVI – reported to OARRS
Lyrica/Neurotin side effects
CNS depression
dose accumulation w/ renal insufficiency
anti-depressants and anxiety
SSRIs are D.O.C. for several anxiety disorders
some SNRI
may worsen anxiety
other agents used in anxiety disorders
- B-Blockers
- MAOIs
- Antihistamines
- Barbituates
- Pregabalin/Gabapentin
- Antipsychoitcs
beta blockers in anxiety (use)
symptom control (tachycardia)
Antihistamines with anxiety
hydroxyzine
also used for sedating properties
Recommendations: generalized anxiety disorders
- antidepressants
- BZDs
- Buspirone
- Pregabalin, SGAs, valproate
- CBT, psychotherapy
Recommendations: panic disorders
- antidepressants
- BZDs
- CBT, psychotherapy
**buspirone, BBs, antihistamine, SGAs, bupropion, trazodone NOT shown to be effective
– lose adjuncts
Recommendations:
OCD
- Serotonergic agents effective: SSRI
- CBT augmenting SSRI
- Augmentation with haloperidol or SGA may help
** NO benzos
Recommendations:
PTSD
- SSRIs
- Augment with other agents for specific symptoms
- BZDs
- Trauma-focused CBT
other agents used in PTSD
prazosin
anticonvlusants
SGAs
Prazosin
alpha-1 antagonist
used for PTSD associated nightmares
anticonvulsants
used for aggression, anger, depression
SGAs PTSD
used for psychotic symptoms
Recommendations: social anxiety disorder
- CBT most effective
- Antidepressants (12 weeks to work)
- BZDs as adjunct
- Gabapentin/Pregabalin
