PC707 CNS Summaries 2024
.For quick relief of Anxiety: 2 wk course of intermediate acting benzodiazepine PRN Q 8 hrs.
2.Buspirone (BuSpar): o Not habit forming
oNot a CNS depressant
oMOA
•Mostly unknown
•High affinity for serotonin & lesser affinity for dopamine receptors
3.Hydroxyzine (Atarax, Vistaril): o No abuse or addiction concerns
oStrong antihistamine
•Anticholinergic effects
4.Performance anxiety: o Beta-blocker
•Taken an hour before can help decrease symptoms without causing sedation.
•Propranolol (Inderal)
•Atenolol (Tenormin)
5.Info about Benzodiazepines: o PRESCRIBE cautiously & for as short a time as possible!!
oScheduled IV
oLow abuse when used short term
oRoutine daily use may lead to dependence
oQuick relief for anxiety DO NOT STOP abruptly
•Can cause seizures
•Discontinue over many weeks
6.Benzodiazepine MOA: • Rapid onset
•Those with fastest onset are associated w/ abuse
•Metabolized in liver & CYP450
•Use caution if alcohol or drug use is suspected CNS effects
•Sedation
•Decreased anxiety
•Muscle relaxation
•Anti-convulsant action
7.Diazepam (valium): • Long half life
•Effective in reducing spasm & decrease seizure activity
8.Alprazolam (Xanax): • Works quickly
•Moderate half-life
•Rapid relief of symptoms
•Most addictive PC707 CNS Summaries 2024
.Lorazepam (Ativan): • Used for anxiety
•Slow onset
•Shorter half-life
10.SSRIs: o Many types of anxiety disorders
•PTSD
•OCD
•Panic attacks
•Social anxiety
o Paroxetine (paxil)
11.Medications for Anxiety: Benzodiazepines SSRIs
SNRIs
Others... hydroxyzine, propranolol etc.
12.Info for insomnia: •Challenge to promote sleep & avoid dependency on meds
•Essential to rule out other causes
oPain
oSleep apnea
oRestless leg syndrome Psychiatric disorders
•Major depressive disorder
•Bipolar disorder
•PTSD
•Generalized anxiety disorder
•Psychotic disorder
•ADHD
Sleep meds should only be given short-term only
13.OTC for insomnia: •Benadryl
•Tylenol PM
•Both may cause morning drowsiness & anticholinergic effects
•Generally effective for a few days
•Idiosyncratic reaction in children
•Delirium in elderly
14.Benzodiazepines for insomnia: Indicated for short-term; max 10 days
•Habit forming
•Estazolam (ProSom)
•Flurazepam (dalmane)
• Temazepam (restoril)
15.Non-benzodiazepines for insomnia: Eszopiclone (lunesta)
•Is the only recommended drug for long term use PC707 CNS Summaries 2024
Zaleplon (Sonata)
•Max 35 days Zolpidem (ambien)
•Gender specific- lower dose for women
•Sublingual form (Edluar)
•Nasal spray (ZilpiMist)
16.Melatonin herb for insomnia: • OTC 3-6 mg
•No potential for addiction or tolerance
•Maybe helpful for sleep latency if used for several days
17.Off lable for insomnia: Antidepressants
•Frequently used in elderly
•TCAs- use caution
oCause sedation
oMany side effects in elderly
•Mirtazapine (remeron)
•Trazodone (desyrel)
Antihistamines
•Can worsen depression
•Anticholinergic effects in elderly
•Diphenhydramine (Benadryl)
•Hydroxyzine (vistraril) Antipsychotic
•Quetiapine (Seroquel)
oMultiple s/e & costly
oAvoid off label use for insomnia
18.Chronic insomnia: • Duration greater than 6 months Lunesta (eszopiclone)
•Common s/e - bitter taste Rozerem (ramelteon)
•Selective melatonin agonist Herbal remedies
•Melatonin
•Kava
•Valerian
19.Benzodiazepines for anxiety during pregnancy: o Cat D
oContraindicated unless benefits outweigh fetal & neonatal risks
oA/E
•Oral cleft
•Preterm labor
.For quick relief of Anxiety: 2 wk course of intermediate acting benzodiazepine PRN Q 8 hrs.
2.Buspirone (BuSpar): o Not habit forming
oNot a CNS depressant
oMOA
•Mostly unknown
•High affinity for serotonin & lesser affinity for dopamine receptors
3.Hydroxyzine (Atarax, Vistaril): o No abuse or addiction concerns
oStrong antihistamine
•Anticholinergic effects
4.Performance anxiety: o Beta-blocker
•Taken an hour before can help decrease symptoms without causing sedation.
•Propranolol (Inderal)
•Atenolol (Tenormin)
5.Info about Benzodiazepines: o PRESCRIBE cautiously & for as short a time as possible!!
oScheduled IV
oLow abuse when used short term
oRoutine daily use may lead to dependence
oQuick relief for anxiety DO NOT STOP abruptly
•Can cause seizures
•Discontinue over many weeks
6.Benzodiazepine MOA: • Rapid onset
•Those with fastest onset are associated w/ abuse
•Metabolized in liver & CYP450
•Use caution if alcohol or drug use is suspected CNS effects
•Sedation
•Decreased anxiety
•Muscle relaxation
•Anti-convulsant action
7.Diazepam (valium): • Long half life
•Effective in reducing spasm & decrease seizure activity
8.Alprazolam (Xanax): • Works quickly
•Moderate half-life
•Rapid relief of symptoms
•Most addictive PC707 CNS Summaries 2024
.Lorazepam (Ativan): • Used for anxiety
•Slow onset
•Shorter half-life
10.SSRIs: o Many types of anxiety disorders
•PTSD
•OCD
•Panic attacks
•Social anxiety
o Paroxetine (paxil)
11.Medications for Anxiety: Benzodiazepines SSRIs
SNRIs
Others... hydroxyzine, propranolol etc.
12.Info for insomnia: •Challenge to promote sleep & avoid dependency on meds
•Essential to rule out other causes
oPain
oSleep apnea
oRestless leg syndrome Psychiatric disorders
•Major depressive disorder
•Bipolar disorder
•PTSD
•Generalized anxiety disorder
•Psychotic disorder
•ADHD
Sleep meds should only be given short-term only
13.OTC for insomnia: •Benadryl
•Tylenol PM
•Both may cause morning drowsiness & anticholinergic effects
•Generally effective for a few days
•Idiosyncratic reaction in children
•Delirium in elderly
14.Benzodiazepines for insomnia: Indicated for short-term; max 10 days
•Habit forming
•Estazolam (ProSom)
•Flurazepam (dalmane)
• Temazepam (restoril)
15.Non-benzodiazepines for insomnia: Eszopiclone (lunesta)
•Is the only recommended drug for long term use PC707 CNS Summaries 2024
Zaleplon (Sonata)
•Max 35 days Zolpidem (ambien)
•Gender specific- lower dose for women
•Sublingual form (Edluar)
•Nasal spray (ZilpiMist)
16.Melatonin herb for insomnia: • OTC 3-6 mg
•No potential for addiction or tolerance
•Maybe helpful for sleep latency if used for several days
17.Off lable for insomnia: Antidepressants
•Frequently used in elderly
•TCAs- use caution
oCause sedation
oMany side effects in elderly
•Mirtazapine (remeron)
•Trazodone (desyrel)
Antihistamines
•Can worsen depression
•Anticholinergic effects in elderly
•Diphenhydramine (Benadryl)
•Hydroxyzine (vistraril) Antipsychotic
•Quetiapine (Seroquel)
oMultiple s/e & costly
oAvoid off label use for insomnia
18.Chronic insomnia: • Duration greater than 6 months Lunesta (eszopiclone)
•Common s/e - bitter taste Rozerem (ramelteon)
•Selective melatonin agonist Herbal remedies
•Melatonin
•Kava
•Valerian
19.Benzodiazepines for anxiety during pregnancy: o Cat D
oContraindicated unless benefits outweigh fetal & neonatal risks
oA/E
•Oral cleft
•Preterm labor
