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Neuro Pharm 11


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barb interactions
- phenobarbital + cimetidine, erythromycin, clarithromycin, or fluconazole means increased phenobarb
– phenobarbital + rifampin means decreased phenobarb
long-acting benzos for anxiety
- b/c long-lasting active metabolite Nordiazepam
- diazepam, flurazepam, chlordiazepoxide, cloraze-pate
- more daytime sleepiness
shorter-acting benzo's for anxiety
- triazolam and midazolam (for unconcious sedation)
- more sever withdrawl
intermediate acting benzo's for anxiety
lorazepam, alprazolam, temazepam
what decreases benzo level
rifampin, food, antacids
what increases benzo level
Cimetidine, disulfiram, isoniazid, and estrogen
benzos increase the level of
phenytoin, digoxin
Panic Disorder tx
– 1) TCA's (imipramine, clomipramine)
– 2) SSRI's (gold for PD and SAD)
– 3) SNRIs
– 4) benzo’s (alprazolam, clonazepam, lorazepam)
– 5) MAOI's for refractory cases due to SE profile
– initiate at low doses then titrate to avoid temporary worsening of panic sx
OCD tx
– Only effective work w/ S
– Clomipramine (TCA)
- 4 SSRIs – fluoxetine, sertraline, paroxetine, and fluvoxamine
– SSRIs first-line
- sertraline and paroxetine have FDA approval
GAD tx
- BZDs were used, now
– Buspirone
– The SNRI, venlafaxine
– SSRIs paroxetine and citalopram
Social Anxiety Disorder tx
- MAOs OK, but SSRIs 1st line
– sertraline, paroxetine, venlafaxine
– Benzos or β-blockers sometimes uses (performance anxiety)

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