Valium

Wave those magic wands, UTA instructors!

Valium (diazepam) is a benzo indicated for treatment of GAD, PD, and SAD. It can also be used for acute management of violent behaviors because of its rapid sedating and calming effect.

Side effects are the same as that of other benzos. Patient teaching is key!

Valium can also be used to treat alcohol withdrawal, though it is not recommended due to the high frequency of doses.

Ativan

Ativan (Lorazepam) is a benzodiazepine approved for treatment of GAD. It is also used for PD, SAD, and GAD. Agoraphobia is one specific example of something Ativan can help treat.

Like Xanax, Ativan typically is not sleep-producing when given in lower doses. Remember the important patient teaching that goes along with benzos!!

Xanax

I need some of this today.

Xanax (alprazolam) is a benzodiazepine used for short term treatment of anxiety. It is mainly used for GAD, PD, and SAD. Xanax is NOT indicated for primary treatment of PTSD or OCD.

One cool thing about Xanax is that it can treat anxiety without the sedative effect some other anti-anxiety medications have. Now, Xanax IS a benzo, so lots of patient teaching comes with it! remind the patient to use birth control, to avoid alcohol, and to decrease caffeine intake. Remind them that tolerance and dependence may occur, and that withdrawal may occur if they stop taking Xanax after daily use for several months.

**Tolerance and dependency can occur.

3rd Drug Class- Benzodiazepines

Benzopiazepines serve three main therapeutic purposes: 1) anxiety 2) insomnia 3) seizure disorders. Benzos can also be used for alcohol withdrawal, but those are their 3 main uses. They work by potentiating (increasing, enhancing) the action of GABA, which is a neurotransmitter that helps control anxiety, aggression, and excitation.

Benzos can cause depression, dependency, or tolerance, so the are only indicated for short term use. There are long acting and short acting benzos, so I'll make sure I mention that for each specific drug. They are CNS depressants, so side effects include drowsiness, sedation, and cognitive impairment. Make sure you remind your patient taking a benzo to avoid consuming alcohol! Birth control should be used if the woman is of childbearing age, because benzos can cause birth defects.

Benzodiazepines include:
Xanax
Ativan
Valium
Serax
Librium
Tranxene

Quick Atypical Antidepressant Overview

Here's a quick overview:

Pristiq: for depression. Very similar to Effexor.
Cymbalta: for anxiety and depression. Mild side effects. Can treat diabetic peripheral neuropathy.
Effexor: good for treatment-resistant depression. Monitor blood pressure.
Remeron: antianxiety and antidepressive. Faster than SSRIs. Weight gain is common.
Desyrel: antidepressive effects only in high dose. Sedating! Commonly used in combination with others for sleep.
Wellbutrin: antidepressant and smoking cessation aid. Sexual dysfunction and weight gain are NOT side effects. Monitor does! Medication-induced seizures possible.

Typically take 1-4 weeks to work.

11.6.10 - Pristiq

Pristiq (Desvenlafaxine) is not in our textbooks. I looked it up on the FDA website instead :) It is an SNRI used to treat depression. It is very similar to Effexor.

Headache, N/V/D, drowsiness, and increased suicidal ideation, are common side effects. Do not take Pristiq if you are pregnant or planning on becoming pregnant soon, and do not drink alcohol while taking Pristiq. Like always, do not take with an MAOI!

11.5.10 - Remeron

Remeron (Mirtazapine) is a SNDI, a serotonin norepinephrine disinhibitor. It blocks the receptors that normally inhibit norepinephrine and serotonin. This is an interesting one to me! It is the only drug in this specific class. It has both antianxiety and antidepressive effects, and its antidepressive effects may actually occur faster than SSRIs. Remeron is also an antidote to sexual dysfunction secondary to use of SSRIs.

Side effects include sedation that is increased by use of alcohol, benzos, and other CNS depressants. *Teach your patients about this! Do not use with MAOIs either. Major thing to note: typical increase in appetite, weight gain, and cholesterol with the use of Remeron.