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