click below
click below
Normal Size Small Size show me how
Pharm for Anxiety
From ANCC Review
Question | Answer |
---|---|
Risk with management of anxiety disorders | risk of psychological and physical dependence so long term use should be carefully monitored |
When discontinuing meds for anxiety | should taper |
Discontinuation syndromes depend on | length of time on drug, dosage taken, rate of taper, and the half life |
The higher the dose of anxiety med | the shorter the half life, the more severe the withdrawal symptoms |
Withdrawal symptoms of anxiety medications | anxiety, nervousness, diaphoresis, restlessness, irritability, fatigue, light headedness, tremor, insomnia, weakness, risk for seizures and death |
Buspar is a | serotonin partial agonist |
buspirone (BuSpar) dosing | 20-30mg/day (adult) 10-30mg/day (child) |
therapeutic effects of buspar | 4 weeks |
dependence with buspar | no physiological dependence |
Propranolol is a | beta blocker that can be used for anxiety treatment |
propranolol (Inderal) is useful for | performance anxiety where tremor might be a problem. tremor med side effect anxiety in pt with substance abuse/dependence |
dose of propranolol for anxiety | 10-20mg bid or tid |
initiation/acute phase lasts | approx. 12 weeks |
acute phase of anxiety do this | initiate psychotherapy, if necessary initiate SSRI |
Stabilization of anxiety | after 12 - 18 months, discontinuation of medication can be attempted with close follow up |
maintenance of anxiety disorders | respond to relapses with rapid initiation of treatment |
these medications are useful only in short term | benzodiazepines |
as a general approach, begin anxiety tx with | broad spectrum agent - SSRI |
if ADHD symptoms are present in addition to anxiety | adjunctive use of stimulant or buproprion should be considered |
For insomnia, hyperstartle or hyperarousal are present use | clonidine (Catapres) and guanfacine (Tenex) alpha agonists |
use this for acute anxiety and agitation | benzo |
this can be used for mild ADHD | effexor |
first line treatment for anxiety | SSRI for chronic anxiety symptoms associated with panic disorder, phobias, social anxiety d/o and OCD |
therapeutic effects of SSRI on anxiety | 2-4 weeks |
Mechanism of action of benzo | potentiate the effect of GABA, inhibiting neurotransmission in limbic system and cortex |
anti-anxiety effects of benzos are felt in | 30-60minutes |
guidelines for using benzos | lowest possible effective dose for shortest possible period of time |
side effects of benzos | drowsiness, fatigue, depression, dizziness, ataxia, slurred speech, weakness, forgetfulness |
Higher half lives of benzos | require less frequent dosing less variation in plasma concentration less severe withdrawal less rebound |
benzos with long half lives | clonazepam (Klonopin) diazepam (Valium) |
dosing for klonopin | 1-6mg/day (adult) 0.5-2.0mg/day (child) |
dosing for valium | 4-40mg/day |
benzo with an intermediate half life | ativan |
ativan dosing | 1-6mg/day |
benzo with a short half life | alprazolam (Xanax) |
dosing for xanax | 0.5-10mg/day (adult) up to 1.5mg/day (child) |
advantages of benzos with short half lives | less daytime sedation, less drug accumulation |
disadvantage of benzo with short half life | increased risk of addiction |
benzo with short half life and rapid onset is useful for | treatment of insomnia |