Anxiety Medications

Question 1

GAD Excessive anxiety and worry occurring more

Answer 1

days than not > 6 months

Question 2

GAD other criteria

Answer 2

Difficulty in controlling the worry
• Anxiety and worry associ d ate wi ht 3 of the
following symptoms:
– Restlessness, fatigue, decreased concentration,
irritability, muscle tension, sleep

Question 3

GAD first choice

Answer 3

BZD

Question 4

BZD should be used in combination with

Answer 4

anitdepressant

Question 5

limit BZD trial to

Answer 5

1 - 4 weeks

Question 6

relapse rate of BZD is what percentage

Answer 6

50 to 70% in first year

Question 7

Use what type of BZD over wat other type

Answer 7

long acting over short acting

Question 8

Buspirone benefits and draw backs

Answer 8

safer than BZD, but take a longer time to work

Question 9

Side effect for venlafaxine

Answer 9

nausea

Question 10

Somestimes when you start an ssri it might

Answer 10

increase anxiety, but this is temporary.

Question 11

Kava kava associated with

Answer 11

fatal hepatoxicity

FDA warning

Question 12

Valerian has a mild

Answer 12

sedative effects in animals
inconclusive results
no data long-term safety

Question 13

BZD MOA

Answer 13

enhance the inhibitory

neurotransmitter systems that utilize GABA.

Question 14

Indications for BZD

Answer 14

Anxiety
• Panic Attacks
• Bridge to therapy
– Sedation/hypnotic
– Anticonvulsants
– Substance abuse withdrawal
– Depression adjunct

Question 15

Longer half life BZD drugs

Answer 15

diazepam, clonazepam

Question 16

longer half life BZD are used

Answer 16

daily to 2 - 4 times daily

Question 17

longer half life BZD are and show

Answer 17

Less severe withdrawal*

More daytime sedation

Question 18

Shorter half life drugs BZD

Answer 18

lorazepam, alprzolam

Question 19

short half life bzd dosing

Answer 19

three times daily dosing

Question 20

drawbacks to short half life bzd

Answer 20

– 3 times daily dosing*
– More rebound anxiety
– Greater dependence potential

Question 21

BZD side effects

Answer 21

• Sedation
• Dizziness
• Disinhibition
• Respiratory distress
• Mild cognitive impairment
• Anterograde amnesia
• Tolerance, dependence, withdrawal

Question 22

BZD is usually restricted to

Answer 22

two to four week use due to tolerance

Question 23

BZD is a schedule

Answer 23

4 drug

Question 24

BZD has what kind of effects

Answer 24

hypnotic and anxiolytic

Question 25

increasing dose of BZD is required

Answer 25

to prevent withdrawal syndrome

Question 26

With BZD use you will reach a

Answer 26

plateau when no longer efeicve and see increasing symptoms

Question 27

BZD withdrawal syndrome symptoms

Answer 27

``` ƒ Anxiety ƒ Irritability ƒ Insomnia ƒ Fatigue ƒ Muscle twitching ƒ Tremor, shakiness ƒ Sweating ƒ Dizziness ƒ Headache ƒ Nausea; anorexia ƒ Depression ƒ Abnormal sensation of movement ƒ Concentration difficulties ƒ Depersonalization ƒ Increased sensory perception ```

Question 28

The key to limiting withdrawal symptoms from BZD

Answer 28

taper the medication clowling. It typically takes months, achiveing rougly a 10 percent dose reduction per week.

Question 29

other methods to limit BCD rebound anxiety and withdral

Answer 29

ƒ Convert short‐acting benzodiazepines to agent with longer‐acting elimination elimination half‐life prior to tapering tapering - diazepam, clonazepam* ƒ Treat the patient with an antidepressant (6‐8 weeks) before attempting to taper ƒ Commence short‐term cognitive behavioral therapy (eg. several weeks to six months)

Question 30

BZD long term therapy you should monitor

Answer 30

• Long term therapy – CBC – LFTs

Question 31

BZD can give a

Answer 31

false preganancy test

Question 32

BZD drug interactions

Answer 32

– Numerous – Cimetidine, erythromycin, fluoxetine, metoprolol, propranolol, oral contaceptive

Question 33

Long-term acting as adjunct in depression

Answer 33

use a low dose

Question 34

Shorter-acting bzd in management of panic disorder dosing

Answer 34

– 2‐3 times per day for 3 days* | – Start at lowest dose

Question 35

Tapering guidelines

Answer 35

Slow!! Months • Switch from short‐acting to long‐acting (Diazepam) • Monitor symptoms • How to withdraw from Benzodiazepines • http://www.benzo.org.uk/manual/bzcha02.ht m

Question 36

BZD drug interactions

Answer 36

``` – Cimetidine – CNS depressants (alcohol, antihistamines, TCAs) – Erythromycin – Propranolol, metoprolol – Oral contraceptive ```

Question 37

BZD pedicatrics

Answer 37

– Few trials – Reported: hallucinations, incoordination, insomnia, light sensitivity, fear – Not recommended recommended < 18 years

Question 38

Elderly BZD

Answer 38

Increased risk of falls, CNS effects – Lipophilic – Decreased metabolism

Question 39

BZD preganancy and lactation

Answer 39

not recommended - cleft pallet

Question 40

BZD like drugs NAMES

Answer 40

– Eszopiclone (Lunesta) – Zaleplon (Sonata) – Zolpidem (Ambien)

Question 41

Indications for BZD liked drugs

Answer 41

– Insomnia – Weak muscle relaxant – Weak anti‐seizure effects

Question 42

Dosing BZD like drugs

Answer 42

* Start low, titrate up * HS dosing * Recommend short term treatment * 7‐14 days * Taper off

Question 43

Buspirone indicatiosn

Answer 43

– GAD, Social phobia, adjunct in OCD and PTSD; not | effective for immediate use

Question 44

Buspirone cant take

Answer 44

4 to 12 weeks to take effect

Question 45

Buspirone facts

Answer 45

Not a central central nervous nervous system depressant depressant • Has no abuse potential • Does not intensify the effects of central nervous system depressants • Anxiolytic effects develop slowly