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Pharm for Anxiety

From ANCC Review

QuestionAnswer
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
Created by: jonquil