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Pharm Brainscapes by Cheryl and Phil > Anti-Anxiety 35 > Flashcards

Anti-Anxiety 35 Flashcards

1
Q

• Anxiety is an uncomfortable state that has both_____ and ______components.

A

psychologic and physical

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2
Q

The physical component manifests as ? (8)

A

tachycardia, palpitations, trembling, dry mouth, sweating, weakness, fatigue, and shortness of breath.

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3
Q

How many people in the US develop an anxiety D/O at some point in their lives

A

25%

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4
Q

The five most common anxiety disorders are ?

A

generalized anxiety disorder (GAS),

panic disorder,

obsessive-compulsive disorder (OCD),

social anxiety disorder,

and post-traumatic stress disorder (PTSD).

Although each type is distinct, they all have one element in common: an unhealthy level of anxiety.

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5
Q

What 2 classes of drugs treat anxiety

A

benzodiazepines and selective serotonin reuptake inhibitors (SSRIs).

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6
Q

benzodiazepines are used primarly for

A

Generlized anxiety Disorder (GAD)

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7
Q

Generalized anxiety disorder (GAD) is

A

a chronic condition characterized by uncontrollable worrying.

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8
Q

The hallmark (symptoms) of GAD is

A

unrealistic or excessive anxiety about several events or activities that lasts 6 months or longer. Other psychologic manifestations include vigilance, tension, apprehension, poor concentration, and difficulty falling or staying asleep. Somatic manifestations include trembling, muscle tension, restlessness, and signs of autonomic hyperactivity, such as palpitations, tachycardia, sweating, and cold clammy hands.

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9
Q

GAD can be managed with ????

A

Both nondrug therapy and with drugs

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10
Q

Nondrug approaches for treatment of GAD include

A

supportive therapy, cognitive behavioral therapy, biofeedback, and relaxation training.

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11
Q

Current first-line choices for drug therapy of GAD are?

A

benzodiazepines, buspirone, and four antidepressants: (venlafaxine, paroxetine, escitalopram, and duloxetine. )

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12
Q

The _______are the preferred drugs for immediate stabilization, especially when anxiety is severe. However, for long-term management, ______and the _______ are preferred.

A

benzodiazepines (short-term), buspirone , antidepressants (longterm)

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13
Q

For Benzos, Their benefits derive from ?

A

enhancement of responses to gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter.

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14
Q

Benzos: The onset of effects is immediate, and the margin of safety is high. Principal side effects are ?

A

sedation and psychomotor slowing. Patients should be warned about these effects and informed that they will subside in 7 to 10 days.

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15
Q

The agents (drugs) prescribed most often are ??

A

alprazolam and lorazepam.

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16
Q

Benzodiazepines can cause ?

A

physical dependence, which can make withdrawal extremely hard for some patients.

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17
Q

What is the difficulty in withdrawing and or detoxing from Benzos?

A

The difficulty is that withdrawal produces intense anxiety, which people with panic disorder may find intolerable. To minimize withdrawal symptoms, benzodiazepines should be withdrawn very slowly—over a period of several months.

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18
Q

Buspirone is an ?

A

anxiolytic drug that differs significantly from the benzodiazepines.

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19
Q

Buspirone is not a central nervous system (CNS) depressant. TRUE or False?

A

TRUE

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20
Q

For the treatment of anxiety, buspirone is as effective as the _______?

A

benzodiazepines

21
Q

Advantage of Buspirone over Benzos

A

(1) it does not cause sedation; (2) it has no abuse potential; and (3) it does not intensify the effects of CNS depressants.

22
Q

Disadvantage of Buspirone over Benzos

A

ITS SLOW. Buspirone’s major disadvantage is that its anxiolytic effects develop slowly; initial responses take a week to appear, and several more weeks must pass before responses peak. Buspirone is labeled only for short-term treatment of anxiety.

23
Q

The MOA for buspirone is ____?

A

The mechanism by which buspirone relieves anxiety has not been established. The drug binds with high affinity to receptors for serotonin and with lower affinity to receptors for dopamine. Buspirone does not bind to receptors for GABA or benzodiazepines.

24
Q

How is buspirone tolerated and what are the potential side effects

A

is generally well tolerated. The most common reactions are dizziness, nausea, headache, nervousness, lightheadedness, and excitement.

25
Q

Levels of buspirone can be greatly increased (5- to 13-fold) by ______?

A

erythromycin and ketoconazole. Levels can also be increased by grapefruit juice. Elevated levels may cause drowsiness and subjective effects (dysphoria, a “spacey” feeling).

26
Q

What are the 4 anti-depressants used to treat GAD?

A

venlafaxine, paroxetine, escitalopram, and duloxetine

27
Q

Panic disorder is characterized by recurrent, intensely uncomfortable episodes known as ______ _____

A

panic attacks.

A panic attack is an abrupt surge of intense fear or intense discomfort during which four or more of the following are present: palpitations, pounding heart, or racing heartbeat; sweating; trembling or shaking; sensation of shortness of breath or smothering; feeling of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, lightheaded, or faint; chills or heat sensations; paresthesias; derealization or depersonalization; fear of losing control or going crazy; and fear of dying. Panic symptoms reach a peak in a few minutes and then dissipate within 30 minutes.

28
Q

Perhaps 50% of patients who get panic disorder also experience _______?

A

agoraphobia:

a condition characterized by anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might be unavailable if a panic attack should occur.

29
Q

Agoraphobia leads to ?

A

avoidance of certain places and situations. In extreme cases, agoraphobics may never set foot outside the home.

30
Q

Between __% and __% of patients with panic disorder respond well to treatment.

A

70 to 90 %

31
Q

What Two modalities may be used ?

A

: drug therapy and cognitive behavioral therapy (CBT).

32
Q

Panic disorder responds well to ????

A

all three major classes of antidepressants: SSRIs, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). With all three, full benefits take 6 to 12 weeks to develop.

33
Q

Because of their better tolerability, ____ are preferred over ____ and _____

A

SSRIs are preferred to TCAs and MAOIs.

34
Q

SSRIs are first-line drugs for panic disorder. The SSRIs reduce what? (4 things dealing with anx)

A

anticipatory anxiety, avoidance behavior, and the frequency and intensity of attacks

35
Q

Obsessive-compulsive disorder (OCD) is a potentially disabling condition characterized by ?

A

persistent obsessions and compulsions that cause marked distress, consume at least 1 hour a day, and significantly interfere with daily living

36
Q

An obsession is defined as??

A

a recurrent, persistent thought, impulse, or mental image that is unwanted and distressing and comes involuntarily to mind despite attempts to ignore or suppress it.

37
Q

A compulsion is a _____?

A

ritualized behavior or mental act that the patient is driven to perform in response to his or her obsessions. In the patient’s mind, carrying out the compulsion is essential to prevent some horrible event from occurring. If performance of the compulsion is suppressed or postponed, the patient experiences increased anxiety.

38
Q

Patients with OCD respond to _____ and _____?

A

drugs and behavioral therapy. Optimal treatment consists of both. Behavioral therapy is probably more important in OCD than in any other psychiatric disorder.

39
Q

Five drugs have been approved for OCD: ?

A

four SSRIs and one TCA (clomipramine). All five enhance serotonergic transmission. The SSRIs are better tolerated than clomipramine and hence are preferred.

40
Q

The SSRIs are first-line drugs for OCD; they reduce symptoms by _______?

A

enhancing serotonergic transmission.

They are all equally effective, although individual patients may respond better to one than to another. With all, beneficial effects develop slowly, taking several months to become maximal.

41
Q

Social anxiety disorder, formerly known as social phobia, is characterized by an ______?

A

intense, irrational fear of situations in which one might be scrutinized by others or might do something that is embarrassing or humiliating.

42
Q

Social anxiety disorder has two principal forms:

A

generalized and performance only. In the generalized form, the person fears nearly all social and performance situations. In the performance-only form, fear is limited to speaking or performing in public.

43
Q

Social anxiety is the most common anxiety disorder. True or false?

A

TRUE

44
Q

Social anxiety disorder can be treated with ?

A

psychotherapy, drug therapy, or both.

45
Q

The ______ are first-line drugs for most patients with social anxiety disorder

A

SSRIs

These drugs are especially well suited for patients who fear multiple situations and are obliged to face those situations on a regular basis. Initial effects take about 4 weeks to develop; optimal effects are seen in 8 to 12 weeks. Patients should be informed that benefits will be delayed.

46
Q

______ and _____ ____ can benefit patients with performance anxiety. When taken 1 to 2 hours before a scheduled performance, beta blockers can reduce symptoms caused by autonomic hyperactivity.

A

Propranolol and other beta blockers

47
Q

Post-traumatic stress disorder (PTSD) develops after a .

A

traumatic event that elicited an immediate reaction of fear, helplessness, or horror

48
Q

PTSD has three core symptoms:

A

re-experiencing the event,

avoiding reminders of the event (coupled with generalized emotional numbing),

persistent state of hyperarousal.

49
Q

The optimal treatment for PTSD, whether psychotherapy and/or drugs,

A

has not yet been established…

Pharm Brainscapes by Cheryl and Phil (6 decks)

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