Long term:
- Antidepressants [DOC]
- BuSpar (antianxiety
- not related to BZD or barbituates = minimal side effect;
- a novel antianxiety agent with no other members in its class;
- Unlike the immediate relief of symptoms that occurs with benzodiazepine therapy, buspirone's onset of action takes two to three weeks = 2-3 wk for full efficacy)
Short term (ER for panic):
- BZD (Oral, IV - early onset but high abuse potential)
- Immediate onset & short half life: IV Lorazepam (Ativan)
- Drugs: Lorazepam (Ativan); Alprazolam (Xanax); Clonazepam (Klonopin)
- Mnemonics: LA-AX-Clo =LAX Clorox eases ur zepam anxiety = Lorazepam (Ativan); Alprazolam (Xanax); Clonazepam (Klonopin)
- lead to dependence; that is, withdrawal symptoms occur once the medications are discontinued. Withdrawal symptoms include anxiety, irritability and insomnia, and it can be difficult to differentiate between withdrawal symptoms and the recurrence of anxiety. Seizures occur rarely during withdrawal.28 Withdrawal symptoms tend to be more severe with higher dosages, with agents that have short half-lives, with rapidly tapered dosages, and in patients with current tobacco use or with a history of illegal drug use.15 The risk of dependence increases as the dosage and the duration of treatment increases, but it can occur even when appropriate dosages are used continuously for three months.4,27 Withdrawal symptoms begin six to 12 hours after the last dose of an agent with a short half-life and 24 to 48 hours after the last dose of an agent with a longer half-life.27 In patients who have taken a benzodiazepine for more than six weeks, the dosage should be decreased by 25 percent or less per week to prevent withdrawal symptoms.4 Patients may experience rebound anxiety (akin to the rebound hypertension that occurs when some antihypertensives are discontinued) once the tapering process is completed, but this is transient and ends within 48 to 72 hours.28 Once the rebound anxiety ends, a patient may re-experience the original symptoms of anxiety, referred to as recurrent anxiety.
PRN (physiological such as fast HR, tremors, trembling, blushing; circumscribed PTSD):
- Beta blockers - Propanolol (Inderal); Atenolol (Tenormin); Nadelol (Corgard) (Pre-treatment EKG for baseline, Tx: always start with lowest dose, elder caution!)
Anti-anxiety drugs (Ativan, Xanax),
antidepressants (Prozac,
Paxil, Zoloft)
beta-blockers (atenolol, propranolol)
References/Quotes:
http://www.aafp.org/afp/2000/1001/p1591.html#afp20001001p1591-b15
http://emedicine.medscape.com/article/286227-medication#7
Post a Comment