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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 |
Created by:
jonquil
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