PC707 Module 7 Central Nervous System Exam with 100% Verified and Updated Solutions

PC707 Module 7 Central Nervous System Exam with 100% Verified and Updated Solutions What classification of medications are first-line treatment for anxiety? SSRIs & SNRIs are used for long-term, maintenance. These take about 4-6 weeks to really work (Evidence-based treatment recommendations demonstrate that the most effective treatment for anxiety disorders is a combination of psychotherapy and pharmacotherapy.) ********** Benzodiazepines are for acute situational anxiety. Use with caution is concomitant usage of opioids. These both have a risk for abuse. Don't prescribe more than 30 tablets at a time. No refills. Beta-Blockers are nice for preventing performance anxiety; they affect norepinephrine Define Generalized anxiety disorder a chronic condition characterized by excessive worry and patients suffer from somatic and psychological anxiety symptoms such as palpitations, nausea, muscle tension, trouble concentrating, insomnia, and uncontrollable worry Treatment: Benzodiazepines, SSRI, SNRI, Buspirone, psychotherapy Medication Examples: paroxetine (Paxil - SSRI) duloxetine (Cymbalta - SNRI) escitalopram (Lexapro - SSRI) venlafaxine (Effexor - SNRI) Buspirone (BuSpar) Define Panic disorder Anxiety attacks with sudden onset resulting in physical manifestations of anxiety such as palpitations, sweating, tremor, chest pain, abdominal pain, and more. Panic attacks can be caused by a trigger or appear for no obvious reason Treatments: Benzodiazepines, SSRI, SNRI Example Medications: fluoxetine (Prozac) - SSRI paroxetine (Paxil) - SSRI sertraline (Zoloft) - SSRI venlafaxine (Effexor) - SNRI Define Acute anxiety This type of anxiety is usually situational and can occur with a specific experience or stressor such as giving a presentation or flying on an airplane Treatments: Benzodiazepines, antihistamines, Beta-Blocker Medication Examples: hydroxyzine (Atarax, Vistaril) - Antihistamine propranolol (Inderal®) - Beta Blocker atenolol (Tenormin®) - Beta Blocker What are the five classifications of anxiolytics? Benzodiazepines (Diazepam [Valium]) Azapirones (Buspirone [BuSpar]) SSRI (escitalopram [Lexapro], paroxetine [Paxil]) Beta-blockers (Propranolol [Inderal], atenolol [Tenormin]) Sedative antihistamines (hydroxyzine [Atarax, Vistaril]) Benzodiazapines & Half-Life The primary differences amongst the benzodiazepines are their onset of action. If the choice is made to start benzodiazepines, consider the half-life of the drug and the indication for its use. Patients may come to expect almost immediate relief of their anxiety and be reluctant to switch to another agent. To reinforce one of the most important "take-home" messages for this class of medication, prescribe benzodiazepines cautiously and for as short a time as possible. Diazepam (Valium) has a fairly long half-life. It is used effectively to help reduce spasm and decrease seizure activity. Alprazolam (Xanax) works quickly and has a moderate half-life. Alprazolam's quick onset leads to rapid relief of symptoms. Lorazepam (Ativan) is commonly used for anxiety--it has a slower onset and a shorter half-life. Off-label drugs for insomnia Antidepressants: Mirtazapine (Remeron), trazodone (Desyrel) are frequently used in treating insomnia in the elderly due to reassuring safety profiles. Although tricyclic antidepressants (TCAs) cause sedation, due to significant side effects, particularly in the elderly, TCAs are used infrequently. Antihistamines: Diphenhydramine (Benadryl) and hydroxyzine (Vistaril). However, if the patient has depression, antihistamines can worsen depression and if they are elderly they can cause anticholinergic side effects (so avoid those patient populations). Antipsychotic: Quetiapine (Seroquel), a second-generation antipsychotic causes sedation but it has multiple side effects and is costly. Avoid off-label use for insomnia. If a patient suffers from mild depression and has difficulty with sleeping, trazodone is often given before bed due to its sedative effects. This medication produces a moderate blockade of 5HT reuptake. Overdose is less of a risk with this drug than with TCAs. Drugs for Chronic Insomnia Lunesta (eszopiclone) - Schedule IV Rozerem (ramelteon) - Not a controlled substance Patient teaching regarding Sleep Medications - Do not take unless you have 7-8 hours to sleep - Take on an empty stomach at least 30 minutes before bedtime - Drugs with long half-lives (eszopiclone [Lunesta]) are associated with a higher risk of next-day impairment - Sleepwalking, sleep driving, sleep eating, sleep sex have been reported with zolpidem and other "Z-drugs" (Z-drugs are drugs for sleep) - Do not use with other CNS depressants or alcohol Anxiolytics and Sleep Medication use in Pregnancy Benzodiazepines and pregnancy. The vast majority of benzodiazepines are pregnancy category D. They are contraindicated except for rare exceptions when their benefits outweigh fetal and neonatal