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Anxiety - Coggle Diagram

- - - - Mechanism of Action
        
        Modulates the benzodiazepine receptor on postsynaptic GABA neurons at sites within the central nervous system, causing an influx of chloride ions, which in turn hyperpolarizes the cell and abates neuronal firing concomitant with most anxiety disorders.
      - Monitoring Parameters
        
        Respiratory and cardiovascular status
      - Side Effects
        
        impairment of psychomotor function
        
        amnesia
        
        dependence and wtihdrawal
        
        Drowsiness, fatigue
      - Black Box Warning: Avoid Concomitant Use with Opioids
        
        can cause sedation & respiratory depression
      - Duration
        
        Typically used short term (<12 weeks) until concurrent therapy is effective at controlling symptoms.
        
        Can be used long term in low doses when other therapies are innefective
      - Education/Counseling
        
        Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Protect the orally disintegrating tablets from moisture. Throw away any cotton that was in the bottle and reseal it tightly after each use.
        
        Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.
        
        Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
      - ADR
        
        Includes swelling, rash, itching, and shortness of breath.
    - - Lorazepam (Ativan)
        
        PK/PD
        
        Half life: 12-18 hours
        
        Hepatic clearance: glucuronidation
        
        Fast Onset: 1-3 hours
        
        Duration: 6-8hrs
        
        Oral bioavailability: 90%
        
        Dosing (for GAD)
        
        Initial: 2-3 mg/day divided into 2-3 doses/day; Maintenance: 2-6 mg/day divided into 2-3 doses/day
        
        How Supplied
        
        oral solution; injection solution; oral tablet
        
        Special Populations
        
        Elderly
        
        Increased Risk of death with use
        
        Increased risk of falls
        
        Pediatric
        
        Long term exposure to children <3yo may effect brain development and lead to cognitive/behavioral problems
        
        Contraindications: narrow-angle glaucoma; severe respiratory insufficiency; sleep apnea
        
        Drug Interactions Category: High; use drug-drug interaction tool before prescribing
      - Alprazolam (Xanax)
        
        PK/PD
        
        80% renal clearance
        
        Bioavalability
        
        Immediate release: 84%-92%
        
        Extended release: 90%
        
        80% protein binding, primarily to albumin
        
        Metabolized by CYP3A4
        
        Half life: 6-27 hrs
        
        Drug Interactions Category: High; use drug-drug interaction tool before prescribing
        
        Contraindications: Acute narrow-angle glaucoma; hypersensitivity to benzodiazepines or excipients; concurrent use with ketoconazole, itraconazole or otherCYP3A4 inhibitors; Myasthenia gravis; severe hepatic insufficiency; severe respiratory insufficiency; sleep apnea
        
        Dose: Initial: 1-2 mg/day divided into 3-4 doses/day Maintenance: 2-6 mg/day divided into 3-4 doses/day (for GAD)
        
        Special populations
        
        Elderly
        
        May be at an increased risk of death
        
        Benzodiazepines associated with increased risk of falls
        
        Obese
        
        Use with caution in obese patients
      - Diazepam (Valium)
        
        Pregnancy
        
        preferred agent if benzodiazepines are necessary
        
        Contraindicated in nursing mothers
        
        PK/PD
        
        Long half life (20-80 hours)
        
        fast onset (30 to 60 min)
        
        high lipophilicity (rapid absoprtion into CNS)
        
        Primarily metabolized by CYP2C19 & CYP3A4
        
        Dosing (for GAD)
        
        Oral: 2-10 mg 2-4 times/day; IV/IM: 2-10 mg every 3-4 hours prn
        
        Max dosage for Geriatric patients: 20 mg/day
        
        Initial: 2-5 mg one to two times/day; can increase up to 40 mg/day divided into 2-4 doses/day
        
        Drug Interactions Category: High; use drug-drug interaction tool before prescribing
        
        Contraindications: acute narrow-angle glaucoma; myasthenia gravis; under 6 months old; severe hepatic or respiratory deficiency; sleep apnea