Anxiety Disorder/Sleep Disorder Flashcards
(22 cards)
First-line treatment for anxiety
SSRIs and SNRIs (*not all)
Second-line treatment for anxiety
Buspirone (can be used with antidepressants).
Tricyclic antidepressants, Pregabalin, and Propranolol are not FDA approved but are used.
Hydroxyzine (PRN use only d/t sedating effect)
Buspirone is a major substrate of what?
CYP3A4 (avoid inhibitors including grapefruit juice!)
Benzodiazepine use should be limited to what duration?
no more than 1 to 2 weeks. Should be tapered off slowly
Elderly-friendly benzodiazepines
LOT: Lorazepam, Oxazepam, Temazepam (also liver-friendly)
Liver-friendly benzodiazepines
LOT: Lorazepam, Oxazepam, Temazepam (also elderly-friendly)
Benzodiazepines for anxiety
CLAD: Clonazepam, Lorazepam, Alprazolam, Diazepam
Benzodiazepines for sleep
Lorazepam and Temazepam
Should BZD be used in pregnant patients?
No. Crosses placenta and causes birth defects and withdrawal syndrome in infants
Fast onset BZDs
Diazepam, Temazepam, ChlorazePATE
Intermediate onset BZDs
Alprazolam (RxPrep says fast), Lorazepam, ClonazePAM, Chlordiazepoxide
Slow onset BZDs
Oxazepam
BZDs used for alcohol withdrawal syndrome
Lorazepam, diazepam, chlordiazepoxide
Antidote for BZD overdose
flumazenil
Treatment to help fall asleep
Eszopiclone, Ramelteon, Zaleplon, Zolpidem
Treatment to help stay asleep
Eszopiclone, Doxepin, Suvorexant, Zolpidem
Treatment to help both fall and stay asleep
Eszopiclone and Zolpidem
Diagnosis criteria for chronic insomnia
insomnia symptoms at least 3 times per week for at least 3 months
RLS treatment
pramipexole, ropinirole, rotigotine (patch), and gabapentin
Narcolepsy treatment
Daytime Meds: Modafinil, Armodafinil
Nighttime Med: Sodium Oxybate (maybe used in addition to the daytime meds)
Very serious SE of Modafinil and Armodafinil
rash that can be life-threatening
Why does Sodium Oxybate require REMS
It’s a “date rape” drug. REMS program to make sure it is used for narcolepsy.
