Lorazepam anxiety

Lorazepam Anxiety, preop sedation, status epilepticus (IV) No active metabolites... 

Benzodiazepines, ie, the hiU BZR agonists, are prescribed for anxiety, insomnia, sedation, myorelaxation, and as anticonvulsants (97). Those benzodiazepines most commonly prescribed for the treatment of anxiety disorders are lorazepam (19), alprazolam (20), diazepam (21), bromazepam (22), chlorazepate (23), and oxazepam (24). These dmgs together represent about 70% of total... 

A class of sedative/hypnotic type drug that exert their effects through the benzodiazepine binding site on GABAa receptors. The class consists both of molecules that contain the benzodiazepine moiety, for example diazepam, lorazepam and flunitrazepam, and the newer, non-benzodiazepine compounds such as zolpidem, zopiclone, indiplon and zaleplon. BzRAs are primarily used for the treatment of anxiety, insomnia and to elicit varying levels of sedation. The wide selection of compounds currently available affords the prescribing clinician extensive options in terms of relative efficacies and durations of action. 

The benzodiazepine, lorazepam, acts allosterically on GABAa receptors to facilitate the actions of GABA. Lorazepam has some antiemetic activity in cancer chemotherapy. When used in combination therapy, it does not appear to add to antiemetic control but may contribute to a reduction in anxiety. 

However, lorazepam and oxazepam are relatively safe for older adults when given in normal dosages. Buspirone (BuSpar) also is a safe choice for older adults with anxiety because it does not cause excessive sedation, and the risk of falling is not as great. Before bus-pirone therapy is begun, benzodiazepines and sedatives and hypnotics are gradually withdrawn. Buspirone, unlike most of the benzodiazepines, must be taken regularly and is not effective on an as-needed basis. 

Medical use of benzodiazepines has been declining. Prescribing trends show an overall decline in the number of all benzodiazepine prescriptions written, with a market shift to increased prescribing of short elimination half-life agents (lorazepam, alprazolam), compared with long-elimination half-life agents (diazepam, chlordiazepoxide) (Ciraulo et al. 2004). In 2001, alprazolam was the most widely prescribed benzodiazepine (Ciraulo et al. 2004), and it also was the most widely prescribed psychiatric medication in that year for mood and anxiety disorders (Stahl 2002). 

Table 32.1 describes 30 persons who have been observed to use one of four available therapeutic compounds for the treatment of one of three possible disorders. The four compounds in this measurement table are the benzodiazepine tranquillizers Clonazepam (C), Diazepam (D), Lorazepam (L) and Triazolam (T). The three disorders are anxiety (A), epilepsy (E) and sleep disturbance (S). In this example, both measurements (compounds and disorders) are defined on nominal scales. Measurements can also be defined on ordinal scales, or on interval and ratio scales in which case they need to be subdivided in discrete and non-overlapping categories. 

In Table 32.7 we observe a contrast (in the sense of difference) along the first row-singular vector u, between Clonazepam (0.750) and Lorazepam (-0.619). Similarly we observe a contrast along the first column-singular vector v, between epilepsy (0.762) and anxiety (-0.644). If we combine these two observations then we find that the first singular vector (expressed by both u, and v,) is dominated by the positive correspondence between Clonazepam and epilepsy and between Lorazepam and anxiety. Equivalently, the observations lead to a negative correspondence between Clonazepam and anxiety, and between Lorazepam and epilepsy. In a similar way we can interpret the second singular vector (expressed by both U2 and V2) in terms of positive correspondences between Triazolam and sleep and between Diazepam and anxiety. 

The two plots can be superimposed into a biplot as shown in Fig. 32.7. Such a biplot reveals the correspondences between the rows and columns of the contingency table. The compound Triazolam is specific for the treatment of sleep disturbances. Anxiety is treated preferentially by both Lorazepam and Diazepam. The latter is also used for treating epilepsy. Clonazepam is specifically used with epilepsy. Note that distances between compounds and disorders are not to be considered. This would be a serious error of interpretation. A positive correspondence between a compound and a disorder is evidenced by relatively large distances from the origin and a common orientation (e.g. sleep disturbance and Triazolam). A negative correspondence is manifest in the case of relatively large distances from the origin and opposite orientations (e.g. sleep disturbance and Diazepam). 

Fig. 32.6. (a) Generalized score plot derived by correspondence factor analysis (CFA) from Table 32.4. The figure shows the distance of Triazolam from the origin, and the distance between Triazolam and Lorazepam. (b) Generalized loading plot derived by CFA from Table 32.4. The figure shows the distance of epilepsy from the origin, and the distance between epilepsy and anxiety. 

Cocaine or stimulant intoxication may require administration of a small dose of a short-acting benzodiazepine (e.g., lorazepam 1 to 2 mg) for agitation or severe anxiety. Antipsychotics (e.g., haloperidol 2 to 5 mg) should be used only if psychosis is present. If hyperthermia is present, initiate cooling measures. 

Haldol for agitation, lorazepam for anxiety, temazepam or zolpidem for insomnia. 

Lorazepam and oxazepam are less lipophilic and have a slower onset but a longer duration of action. They are not recommended for immediate relief of anxiety. 

High-potency benzodiazepines (e.g., clonazepam and lorazepam) are common alternatives to or in combination with antipsychotics for acute mania, agitation, anxiety, panic, and insomnia or in those who cannot take mood stabilizers. Lorazepam IM may be used for acute agitation. A relative contraindication for long-term benzodiazepines is a history of drug or alcohol abuse or dependency. 

Delle Chiaie, R., Pancheri, P., Casacchia, M., Stratta, P., Kotzalidis, G.D. and Zibellini, M. (1995) Assessment of the efficacy of buspirone in patients affected by generalized anxiety disorder, shifting to buspirone from prior treatment with lorazepam a placebo-controlled, doubleblind study. Journal of Clinical Psychopharmacology, 15,... 

Lorazepam Ativan Oral, IV, IM Intermediate 1-10 Anxiety disorders, alcohol withdrawal, insomnia... 

Anxiolytics. The use of anxiety-reducing medications has not been systematically assessed in the treatment of AN. Nevertheless, many clinicians anecdotally report that the use of short-acting benzodiazepine such as lorazepam (Ativan) prior to mealtime diminishes anticipatory anxiety and thereby facilitates refeeding. 

Anxiety. Like psychosis, choosing a medication to treat anxiety in demented patients depends in large part on whether the anxiety is acute or longstanding. Acute severe anxiety requires rapid relief. For this, we recommend a benzodiazepine. Our first choice is lorazepam (Ativan) that is given as needed at 0.25-0.5 mg per dose. We prefer lorazepam because elderly patients tolerate it well (i.e., they metabolize it easily), and it is available in both oral and injectable forms. Oxazepam (Serax) is another benzodiazepine that older patients metabolize easily, but it is only available in oral form. When using benzodiazepines, be careful that your patients do not become overly sedated or delirious. 

Q80 Lorazepam may be used for short-term relief of severe anxiety. Lorazepam is a short-acting benzodiazepine. 

Lorazepam is a short-acting benzodiazepine indicated for use in relieving anxiety and insomnia. Lorazepam may also be administered perioperatively to alleviate pain and in status epilepticus. Imipramine is a tricyclic antidepressant, paroxetine is a selective serotonin re-uptake inhibitor, venlafaxine is a serotonin and adrenaline re-uptake inhibitor and moclobemide is a reversible monoamine oxidase inhibitor. Imipramine, paroxetine, venlafaxine and moclobemide are all classified as antidepressants. 

Benzodiazepines have similar pharmacological properties and are used in anxiety and insomnia. The choice of which benzodiazepine to use usually lies with the pharmacodynamic and pharmacokinetic properties, which vary across the class. For example, diazepam, flurazepam and nitrazepam have a prolonged duration of action whereas lorazepam and temazepam have a shorter duration of action. 

The synthesis of these compounds will be described in Section 3.1, Opioid analgesics. Besides opioids, benzodiazepines (diazepam, lorazepam, and midazolam), which have anxiolytic, sedative, and anticonvulsant effects, that cause amnesia and muscle relaxation, are frequently used to relieve patients anxiety during anesthesia. 

Anxiety For the management of anxiety disorders or for the short-term relief of the symptoms of anxiety (anxiety associated with depression is also responsive) (alprazolam immediate-release and intensol, clorazepate, chlordiazepoxide, diazepam, lorazepam, oxazepam) for the management of anxiety, tension, agitation, and irritability in older patients (oxazepam). 

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