Long-acting agents

Long-acting agents such as salmeterol and for-moterol have superseded short-duration bronchodila-tors such as albuterol and fenoterol. In addition, more potent, site-specific, rapid-onset glucocorticoids, such as fluticosone and budesonide, have superseded the delayed onset of action of less specific molecules such as budesonide. 

We do not use benzodiazepines as readily when treating GAD as we do when treating panic disorder. In comparison to those with panic disorder, most patients with GAD can more easily tolerate the delay in treatment response and even any transient exacerbation of anxiety associated with antidepressant therapy. Benzodiazepines are reserved for those who present with especially severe anxiety that necessitates more rapid relief than an antidepressant can afford and for those who do not achieve a satisfactory response to antidepressant or buspirone therapy. Due to the persistent nature of the anxiety experienced by patients with GAD, shortacting benzodiazepines such as alprazolam are not especially helpful unless dosed 3-4 times per day. Instead, we prefer long-acting agents such as clonazepam. When used to treat GAD, clonazepam should be started at a low dose (0.25-0.5 mg/day) and titrated to higher doses (1-4 mg/day) if clinically necessary. 

McKeage K, Goa KL. Insulin glargine a review of its therapeutic use as a long-acting agent for the management of type 1 and 2 diabetes mellitus. Drugs 2001 61 1599-624. 

Pimozide is a potent, long-acting agent also used for Tourette s syndrome. 

Long-acting Agents for Fertility Regulation Bull World Health Organ 1986 64(4) 587-94. 

Broad-spectrum antibiotic drops, such as 0.3% tobramycin, 0.3% ciprofloxacin, or the newer generation fluoroquinolones, moxifloxacin or gatifloxacin, may be instilled four times daily to prevent secondary infection as the epithelium heals. A broad-spectrum ophthalmic ointment, such as 0.3% ciprofloxacin, may be instilled into the conjunctival sac at bedtime for prophylaxis. In more pronounced cases, pupillary dilation and cyclo-plegia with a long-acting agent such as 5% homatropine may help to relieve pain from associated ciliary spasm. 

Any infiltrative event necessitates discontinuation of contact lens wear. With significant corneal involvement and an anterior chamber reaction, cycloplegia with a long-acting agent such as 5% homatropine enhances patient comfort and helps to relieve iris congestion. 

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