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May 2023 > 221017 PA Anxiety disorder > Flashcards

221017 PA Anxiety disorder Flashcards

1
Q

Anxiety disorder
GAD generalized anxiety disorder

A

excessive worry
hard to control even there is no reason to concern

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2
Q

Anxiety disorder
SAD social anxiety disorder

A

unrealistic fear of social situations => embarrassment feeling

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3
Q

Anxiety disorder
PD panic disorder

A

recurring panic attacks along with anxiety

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4
Q

Anxiety disorder
OCD obsessive compulsive disorder

A

Obsessions: recurring intrusive thoughts => increase anxiety
Compulsions: repeat comforting behaviors to decrease anxiety

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5
Q

Anxiety disorder
PTSD post-traumatic stress disorder

A

resulf from a traumatic life event

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6
Q

Anxiety disorder
Non-pharm

A

Avoid stimulants (caffein, alcohol, diet pill)
Excercise + Sleep hygiene + Stress management
Cognitive behavioural therapy

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7
Q

Anxiety disorder
Medicines

A

SSRI: 1st line, 4-6 wks
SNRI
TCA: 2nd, 2-3 months
MAOI
BZD
Propanolol, buspirone

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8
Q

Anxiety disorder
SNRI venlafaxine

A

1st line, except OCD

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9
Q

Anxiety disorder
SNRI duloxetine

A

1st line in GAD

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10
Q

Anxiety disorder
TCA 2nd indication for which type?

A

GOP (GAD, OCD, PD)
(Tất CẢ GÓP mặt)

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11
Q

Anxiety disorder
TCA: lowest anticholinergic SE risk

A

desipramine

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12
Q

Anxiety disorder
TCA: favour in OCD, highest seizure risk, most serotonergic

A

clomipramine

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13
Q

Anxiety disorder
TCA: highest risk of antihistaminergic SE

A

doxepin

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14
Q

Anxiety disorder
TCA: lowest risk of hypotension

A

nortriptyline

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15
Q

Anxiety disorder
Last line for pt. with persistent symptoms

A

MAOi
Used in SPP (SAD, PD, PTSD)
Morning to avoid overstimulation and insomnia

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16
Q

Anxiety disorder
Avoid eating tyramine rich foods

A

MAOi

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17
Q

Anxiety disorder
2nd line all anxiety
or adjunct in early treatment (panic, agitation)

A

BZD

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18
Q

Anxiety disorder
BZD recommended low dose, short term

A

high potency
Long acting: clonazepam
Immediate: LAB (alprazolam, lorazepam, bromazepam)

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19
Q

Anxiety disorder
BZD cause: high (anxiolytic + sedating)

A

High potency: Lorazepam
Medium potency: Diazepam

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20
Q

Anxiety disorder
Fear of public speaking

A

Propranolol low dose 30’ before event
PS: stage anxiety: add atenolol

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21
Q

Anxiety disorder
Propranolol indication

A

SAD (social)
Tremor
Palpitation

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22
Q

Anxiety disorder
Compared BZD: slow onset of effect, less sedating, low addiction, minimal withdrawal

A

buspirone

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23
Q

Anxiety disorder
buspirone

A

2nd GAD (mild-moderate)
TID

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24
Q

Anxiety disorder
Which medication is used for short-term and rapid relief until the other meds take effect?

A

BZD

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25
Q

Anxiety disorder
Pregnancy: severe

A

SSRI/SNRI
BZD

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26
Q

Anxiety disorder
Pregnancy avoid

A

paroxetine

27
Q

Anxiety disorder
Breastfeeding if necessary

A

paroxetine and sertraline: best
avoid: BZD
PS: OCD escitalopram/sertraline
PTSD: paroxetine/sertraline

28
Q

Anxiety disorder
How long of trial?

A

6-8 weeks
Relief => 1-2 years
Not relief => optimize dose or switch other 1st line

29
Q

Anxiety disorder
Educate pt. when adding BZD

A

Abuse/dependence potential
Sedation risk
Short-term use

30
Q

PS Propranolol in GAD?

A

Propranolol is ineffective in GAD

31
Q

PS BDZ avoided in which trimester

A

BDZ is avoided in 1st trimester

32
Q

PA quiz Not recommend BZD long-term and routine

A

avoid dependence, SEs, tolerance

33
Q

PA quiz: Phobias treatment

A

by CBT
Not treated by medications

34
Q

PA quiz: risk factor of anxiety disorders

A

female
stress/trauma/low socioeconomic
family Hx
substance abuse/psychiatric illness

35
Q

PA quiz: 1st choice for all types of anxiety disorders except OCD

A

venlafaxine

36
Q

PA quiz: GAD treatment

A

1st line: SSRI, SNRI, Pregabalin
2nd line: BZD (short term), Bupropion, Buspirone, Imipramine, Quetiapine, Hydroxyzine

37
Q

PA quiz: Buspirone in GAD

A
  • Slow onset of action
  • Multiple dose TID
    + not abuse as BZD
38
Q

PA quiz: TCAs usage limit

A

SEs
Clomipramine
Imipramine
Desipramine

39
Q

PA quiz: Drug interaction related to MAOi (tranylcypromine) causes hypertensive crisis

A

MAOi + levodopa
MAOi + sympathomimetics (epinephrine, dopamine, salbutamol, pseudoephedrine, methyldopa..)
MAOi + tyramine (food)

40
Q

PA quiz: Public speaking medication

A

Propranolol: effective and safe
SSRIs, SNRIs, TCAs: take 2-3 weeks to become effective => no room for public speaking

41
Q

PA quiz: PD medication

A

1st line: SSRIs, Venlafaxine
2nd line: TCAs, BZD, mirtazapine
Start lowest dose, titrated slowly

42
Q

PA quiz: Antidepressants least likely causes drug withdrawal symptoms due to long half-life

A

Fluoxetine
1-2 weeks symptoms: flu-like, nausea, insomnia..

43
Q

PA quiz: overdose cause fatal

A

TCAs (tachycardia, arrhythmias)

44
Q

PA quiz: SEs of SSRIs resolved after? which SE not resolved?

A

1-2 weeks
nausea, sedation/activation, agitation, and Gl upset.
This is also why short courses of
benzodiazepines are often given in the first 2-4 weeks to manage the anxiety while the body adjusts
to the drug and it becomes effective.
Not resolved: sex dysfunction

45
Q

PA quiz: what to do when TCAs overdose

A

An ECG, gastric lavage with activated charcoal
(where applicable) and a toxicology screen should be done.

46
Q

PA quiz: symptoms and drugs cause serotonin syndromes

A

Symptoms of serotonin syndrome include agitation, tremors, stiff muscles, sweating, increased body temperature, diarrhoea, etc.

Serotonergic drugs include:
* SSRls (selective serotonin reuptake inhibitors)
* SNRls (selective serotonin and norepinephrine reuptake inhibitors)
* TCAs (tricyclic antidepressants)
* cyclobenzaprine
* Tramadol

47
Q

PA quiz: medical cause anxiety disorder

A

Medical causes of anxiety include angina, hyperparathyroidism, hyperthyroidism, hypoglycemia,
hyperkalemia, folate deficiencies, poor pain control, asthma, COPD, anemia, and lupus.

48
Q

PA quiz: medication causes of anxiety disorder

A

Medication causes of anxiety include salbutamol, theophylline, digoxin, anticholinergic,
antihistamines, carbamazepine, stimulants, felodipine, prednisone, pseudoephedrine, ibuprofen,
levodopa, levothyroxine, quinolone, isoniazid, SSRls, and TCAs.

49
Q

PA quiz: which group is recommended first-line for the treatment of all anxiety disorders.

A

SSRls are recommended first-line for the treatment of all anxiety disorders.

50
Q

PA quiz: recognize the time to efficacy for SSRIs

A

4 - 6 weeks
KL should not be assessed for
maximum efficacy until at least 4 - 6 weeks have passed

51
Q

PA quiz: understand how to titrate and taper medications for treatment of anxiety

A

If there is no improvement in anxiety or anxiety symptoms the dose of the medication can be
increased or if at the maximum dose, switch to a different medication.

52
Q

PA quiz: which are the first-line treatment for all anxiety disorders and which are a last-line treatment?

A

SSRls are the first-line treatment for all anxiety disorders and MAOls are a last-line treatment.

53
Q

iMCQ: drug interaction with fluoxetine

A

CYP2D6 metabolism
metoprolol

54
Q

iMCQ BZD withdrawal symptoms

A

a. Flu-like symptoms
b. Hyperreflexia (the presence of hyperactive stretch reflexes of the muscles)
c. Photophobia (is eye discomfort in bright light.)

55
Q

iMCQ: Which of the following can be used as an augmenter (combination therapy) of antidepressant medication (venlafaxine) in GAD?

A

Quetiapine/Risperidone/Olanzapine

56
Q

iMCQ: which is the only SSRI that as an explicitly written indication for social phobia assigned to it by Health Canada.

A

paroxetine

57
Q

iMCQ: only which has been approved by Health Canada for the treatment of PTSD

A

paroxetine

58
Q

iMCQ: which are considered to treat anxiety in pregnancy?

A

SSRIs, SNRIs, BZD

59
Q

iMCQ: how switching from a SNRI (or most other antidepressants) to a RIMA like moclobemide?

A

taper the first drug down and allow for an appropriate wash out period, usually five half-lives of the medication that is being tapered off.

60
Q

iMCQ: which are considered the most sedating of the antidepressants.

A

Amitriptyline and the tricyclic antidepressants

61
Q

iMCQ: which has the most anticholingeric side effects (dry mouth, dizziness, blurred vision) of the drugs listed.

A

Amitriptyline

62
Q

iMCQ: which are the most evidence-based medications for use during breastfeeding.

A

Sertraline, paroxetine, nortriptyline and imipramine

63
Q

iMCQ: which has been to show the least amount of drug exceted in breast milk.

A

Paroxetine

May 2023 (9 decks)

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