Meds for anxiety/Bzds
This med is a beta blocker-POTENT antihypertensive
FDA approved for HTN---->BID or TID up to 400mg
used off label for anxiety-no more than 40mg for anxiety
used for Co-Morbid dx( Uncontrolled htn & anxiety
Side effects:
SB, fatigue, hypotension, fainting, coughing
Propranolol/Inderal
PMHNP knows this medication can be prescribed PRN for a pt with performance anxiety such as public speaking
Bzd used for anesthia
Midazolam/Versad
The PMHNP should know the following about BZD/ ETOH withdrawal:
BZD and ETOH have a short half life-CAN'T STOP ABRUPTLY
Important to taper
Withdrawal occurs 24-72 hrs
The PMHNP should be licensed by the _________ (abbv) to prescribe a __________ substance
DEA
Controlled
Name the BZD:
FDA Panic only-up to 2mg/day
longer 1/2 life daily or BID
off label for other anxiety disorders
less potential for abuse
Clonazepam/Klonopin
****medication of choice if tapering pt off of BZDs, because less symptomatic and less severe
Bzds are used in the hospital & outpt setting to help with anxiety
Clonazepam/Klonopin
Alprazolam/Xanax
Lorazepam/Ativan
Bzd not used much any more
Triazolam/Halcion
The PMHNP knows that BZDs can not be combined with ___________ or ________ and that tolerance can develop.
ETOH or Opioids
Before PMHNP prescribes BZDs to a pt what should be considered, but it depends on facility.
Controlled Substance use agreement.
must make appts
no early refills
UDS
Name the BZD:
FDA approved for anxiety
Liquid, IM, and PO
HEAVILY used in hospital settings
10-20 hr 1/2 life (moderate)
dosed multiple times/day max 6mg/day
Lorazepam/Ativan
VERY useful for acute anxiety
used in ETOH withdrawal
Bzd are used for ETOH withdrawal:
Cholordiazeoxepide/Librium
Oxazepam/Serax- ususally in EU
What is abuse potential?
Using something and over utilizing it, and using it chronically
What is it called when anxiety dips down, skyrockets back up, and the pt wants to take more antianxiety medication?
Rebound anxiety.
abuse may be starting.
Name the BZD:
FDA approved for GAD and Panic
used off label for anxiety
comes in IR & XR
IR abusable d/t short 1/2 life (rebound anxiety)
Dosing:
multiple doses /day up to 6 mg (may see higher
Alprazolam/Xanax
Anticonvulsant used off label for anxiety
used in BZD & ETOH withdrawal to increase seizure threshold (make less likely for pt to have a seizure)
prescribed WITH BZD to help taper off of substance
dosing TID 900-1800 mg /day
side effects: sedation, ataxia, bl. vision, dizziness
can becaome dependent-seen in prison
m
Gabapentin/Neurotin
Bzd used by our Neuro NPs for muscle spasm
Diaxepam/Xanax
How are BZDs simiale to ETOH when it comes to withdrawal?
They both work on the GABA A receptors.
The PMHNP knows that BZDs are used to treat BZD and ETOH withdrawal. What Should be used and why
Long acting BZDs (Klonopin, librium, valium?) because of lower risk for abuse.
Bzds can cause
depression (is comorbidity and can worsen) and respiratory depression
The PMHNP knows the first line of tx for anxiety disorders is (are):
If those classes were not helpful 1Aline would be:
1:SSRI/SNRIs and Buspar (stand alone seratinergic agent . acts on seratonin in the PFC? for less abuse potential
Benzos/Alpha Adrenergic agents
BZd used for sleep aid
Temazepam/Restoril
Withdrawal effects:
Hint CIWA (Clinical Institute Withdrawal Assessment for Alcohol)
Sleep disturbances,
Irritable
Mood changes
Panic
Tremors
Sweating
N/V
Hallucinations
Seizures
Death
When the PMHNP is prescribing BZD. It should be used _________, at the ________ possible dose for the _________ amt of time.
PRN
Lowest
shortest
The PMHNP knows if a pt has a hx of ETOH abuse/dependency the pt is at increased risk for __________ __________ (2 words) if prescribed BZDs
Cross addiction
(ETOH & BZDs work on the same GABA receptors.
PMNNP knows that if Serotonergic agents, Buspar, benzo's and Alpha adrenergic do not work ________ and ________ should be tried.
Lastly if ALL else fails try _________ / __________ & __________ ____________
Benadryl and Hydroxyzine have been used PRN not FDA approved. it is drying nad sedating
TCAs & MAOIs
hypnotics/sedative & atypical antipsychotic with antihistamine properties (Quetiapine/Seroquel or Olanzapine/Zyprexa)