Anxiety

Anxiety: (If night float, consider doing only X 1 dose now.)

  • Hydroxyzine Pamoate (Vistaril): antihistamine (Tx: anxiety, tension, nervousness, N/V, allergies, skin rash, pruritis, hives) (do NOT use in elderly)
    1. 50mg IM/PO
  • Buspirone (Buspar): Start 15mg “dividose” daily (7.5mg PO bid, increase by 5g/day q 2-3 days to usual effective dose of 30mg/day (Max dose: 60mg/day).
  • SSRI: Fluoxetine (Prozac) 20mg PO – take 2 capsules in the AM and 1 in the PM.
  • Effexor (Venlafaxine) 25mg PO qd to bid to tid
  • Chlodiazepoxide (Librium) 5-25mg PO 3-4 times/day
  •  Combinations:
    • Fast: Clonazepam (Klonopin) 0.5mg PO qd AND 2. Slow: Paroxetine (Paxil) 20mg PO qd
    • Fluoxetine HCl – 1mg PO qd (1 tablet each day for 7 days, 2 tablets each day for 7
    • day, and 3 tablets each day for 7 days) AND 2. Oxazepam 10 MG PO tid (give limited amount)
    • Refer to psychology (behavioral health).
  • Ativan (Lorazepam): benzodiazepine (Tx: anxiety, anxiety with depression, and insomnia)
    1. 0.5 – 2mg IV/IM/PO (may worsen confusion in the elderly)
      1. ***Lorazepam (Ativan) 0.5mg IV q4hrs PRN anxiety.***
    2. Do NOT give if COPD: Because pts with COPD retain CO2, do not give them sedatives (like Ativan) because it will exacerbate their CO2 retention (may lead to intubation).
  • Geodon 10mg IM
  • Seroquel 12.5-25mg PO (use 12.5mg in elderly)
  • Hypertension, tachycardia, likely secondary to severe anxiety:
    1. Klonopin (Clonazepam) 1 mg X 1 dose stat (treats panic)
    2. Also give: Metoprolol 25 mg PO bid
  • Other meds…use with caution: Xanax

 

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