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PHRM 845 > 4.6 Pharmacotherapy of anxiety disorders > Flashcards

4.6 Pharmacotherapy of anxiety disorders Flashcards

1
Q

What drugs cause anxiety?

A
  • Albuterol
  • Caffeine (in high doses >800 mg)
  • Decongestants
  • Levothyroxine
  • Steroids
  • Stimulants (ADHD meds)
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2
Q

What is buspirone’s MOA?

A

5HT-1a receptor agonist

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3
Q

What is buspirone used for?

A

Possible 1st line therapy for GAD

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4
Q

What is the dosing of buspirone?

A

Dosed w a target of 10-15 mg 3 times daily (30-45 mg total/day)

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5
Q

How long does it take for buspirone’s effect to start?

A

May take up to 3-4 wks for initial efficacy

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6
Q

What do tx guidelines say about the use of benzos for anxiety?

A
  • Does not support use in routine practice due to misuse potential
  • But effect size for efficacy in anxiety disorders is higher than serotonergic antidepressants
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7
Q

Is long term use of benzos recommended?

A

No

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8
Q

What may withdrawal of benzos cause?

A

Acute withdrawal may lead to life-threatening seizures

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9
Q

What are the warnings associated w benzos?

A
  • Warnings for use of benzos w other CNS depressants and overdose death risk
  • Specific warnings for co-prescribing w opioids
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10
Q

Which benzos have a long-acting active metabolite?

A

Diazepam, clorazepate, chlordiazepoxide

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11
Q

Which benzos do not have an active metabolite?

A

Alprazolam, lorazepam, clonazepam, and oxazepam

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12
Q

What is still a risk (though, not as high) w benzos that doesn’t have an active metabolite?

A

Fall risk

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13
Q

What are the SEs of benzos?

A
  • Sedation
  • Paradoxical excitement
  • Swallowing difficulties
  • Impairment of memory and recall
  • Psychomotor impairment
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14
Q

What is the process of d/c benzos?

A

Slow taper over weeks to months

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15
Q

What pt group are benzos not appropriate in?

A

Elderly

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16
Q

If benzos have to be used in an elderly pt, which ones are preferred?

A

Prefer L-O-T (lorazepam, oxazepam, temazepam)

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17
Q

What is hydroxyzine approved for?

A
  • Hydroxyzine pamoate is FDA approved for tx of GAD
  • Can use HCl salt for lower 10 mg dose
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18
Q

How is hydroxyzine used?

A

Used prn for anxiety or insomnia instead of a benzo

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19
Q

What are the risks associated w hydroxyzine?

A
  • Sedation and anticholinergic SEs are prominent
  • QTc prolongation risk
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20
Q

What pt population should hydroxyzine not be used in and why?

A

Avoid use in elderly due to anticholinergic SEs and fall risk

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21
Q

What is propranolol used for?

A
  • Decrease physiological sxs of acute anxiety (sweating, tachycardia)
  • For non-generalized, performance and situational related SAD
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22
Q

What is the dose of propranolol used for anxiety?

A

10-20 mg 2-3 times daily or LA dosage form

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23
Q

What must be evaluated before a pt can use propranolol?

A

Evaluate for hx/current asthma and CV conditions

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24
Q

What may kava cause and is it recommended?

A
  • May cause hepatotoxicity
  • Not recommended
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25
What is st. john's wart used for?
Anxiety and depression
26
What is the pharmacological profile of st. john's wart to evaluate for?
- Strong 3A4 inducer - Mild MAO-Bi so increased risk for serotonin syndrome
27
Is valerian recommended during pregnancy?
Avoid use during pregnancy
28
Is passionflower recommended during pregnancy?
Avoid in pregnancy due to risk of uterine stimulation induction of early labor
29
What should be avoided if taking chamomile?
Blood thinners and ragweed allergy
30
What may gabapentinoids be used for?
Considered in a pt w bipolar disorder who has anxiety sxs or comorbid neuropathic pain
31
What does sleep medicine not endorse regarding quetiapine?
Quetiapine should not be used for insomnia
32
What is the use of SSRIs/SNRIs?
SSRI/SNRIs are 1st line therapy for ALL anxiety disorders
33
While tx guidelines recommended against its use, what are benzos approved for?
FDA approved to tx anxiety disorders
34
Are atypical antipsychotics FDA approved for anxiety disorders?
No
35
Though atypical antipsychotics are not FDA approved for anxiety disorders, what could they be good for?
Clinical evidence suggests efficacy for tx-resistant OCD (aripiprazole and risperidone)
36
What is GAD?
Excessive anxiety/worry present for AT LEAST 6 months
37
To be diagnosed w GAD, what sxs must be present?
Sxs include at least 3 of the following: - Restlessness/feeling keyed up or on edge - Being easily fatigued - Difficulty concentrating or mind "going blank" - Irritability - Muscle tension - Sleep disturbances
38
What is the 1st line therapy for GAD?
1st line maintenance tx are SSRI antidepressants
39
When are SNRIs used for GAD?
Useful 1st line if pt ALSO HAS a pain syndrome
40
When are benzos used in GAD?
As a "bridge therapy" to cover time until onset of SSRI/SNRI, when appropriate
41
What is social anxiety disorder?
- Persistent fear about social and/or performance situations in which the pt fears embarrassment or humiliation that is unreasonable - Specific situations may be avoided that interferes w pt's normal routine
42
How long must a pt have sxs of social anxiety disorder before it is officially diagnosed?
At least 6 months
43
What is 1st line tx for SAD?
SSRIs (paroxetine and sertraline)
44
What may be useful for SAD if SSRIs don't work?
SNRIs (venlafaxine is FDA approved for SAD)
45
How is panic disorder defined?
- Recurrent, unexpected panic attacks - Abrupt surge of intense fear or discomfort
46
What are the diagnostic criteria for panic disorder?
- At least 4 physical and psychological sxs: sweating, palpitations, nausea, dizziness, fear of losing control, "going crazy, dying - At least one attack followed by one month or more of at least the following: persistent concern about more attacks, maladaptive changes to avoid attacks
47
What is 1st line therapy for panic disorder?
SSRI
48
Can SNRI be used for panic disorder and if so, which one?
Yes, venlafaxine is FDA approved
49
Are benzos considered 1st line for panic disorder?
Benzos should not be considered 1st line unless there is inadequate response to serotonergic drugs
50
Which benzos are FDA approved for panic disorder?
Clonazepam and alprazolam
51
Define compulsions in obsessive-compulsive disorder.
- Repetitive behaviors or mental acts performed in response to obsession - Aimed at reducing or preventing distress - Not always connected to the fear
52
What is 1st line tx for OCD?
SSRIs
53
What level of sx reduction can we see w SSRIs for OCD?
25-50% reduction in sxs can be expected
54
What is considered 2nd line tx for OCD?
Clomipramine (tricyclic antidepressant [TCA]), if the pt fails multiple SSRIs
55
What drug class is not FDA approved for OCD, but may be considered?
- Antipsychotics are not FDA approved for OCD - May be considered as augmentation w SSRI/SNRIs
56
Which antipsychotics can be used to augment SSRI/SNRIs?
- Risperidone has best data for effectiveness - Can also use aripiprazole (inconsistent efficacy)
57
What can cause PTSD?
Exposure to real or threatened death, serious injury, or sexual violence
58
What are the cardinal signs of PTSD?
- Flashbacks - Re-experiencing - Avoidance - Hyper-vigilance - Negative alterations in mood or cognition
59
What are 1st line tx for PTSD?
SSRIs/SNRIs are only FDA approved drug class for PTSD
60
What drug may help w PTSD nightmares?
Prazosin
61
Which class is NOT recommended in PTSD and why?
- Benzos - May worsen recovery from trauma, potentiate fear response, cause suicidal ideations
62
What is common in PTSD and should be treated concurrently?
Substance use
63
What non-pharm therapy may be helpful to tx PTSD?
- Cognitive behavioral therapy - Eye movement desensitization reprocessing
64
What can result from use of SSRI/SNRIs for tx of all anxiety disorders?
"Jitteriness" syndrome
65
How can jitteriness syndrome of SSRI/SNRIs be avoided?
Initial doses should be lower than doses used for depression to minimize this SE
66
How long is the onset of action for SSRI/SNRIs?
2-4 wks
67
What are non-pharm tx of anxiety disorders?
- Psychotherapy - Cognitive behavioral therapy

PHRM 845 (48 decks)

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