Anxiety Flashcards
NT targets for anxiety meds
5HT
GABA
(NE)
which 3 drug classes target 5HT receptors
SSRIs
SNRIs
buspirone
which drug class targets GABA receptors
benzos
which drug targets glutamate
pregabalin
which drug targets NE
bb
when is anxiety pathologic
impaired ability to fxn
1st line drug class for most anxiety disorders
SSRIs
SNRIs
adjunctive therapy for anxiety
buspirone
weaker but fewer s.e
what drug has declining use for anxiety, but is used in acute and situational anxiety
benzos
what drug is not approved in US for anxiety but has similar efficacy to SSRIs/SNRIs
pregabalin
3 classes of drugs for anxiety
antidepressants
benzos
buspirone
benzos to know
alprazolam
clonazepam
lorazepam
diazepam
most efficacious immediate relief of anxiety sx
benzos
but SSRIs are safer and used more
benzos can counteract initial agitation that can occur w. __ when used for anxiety
SSRIs/SNRIs
role of benzos in anxiety
bridge pt while waiting for onset of SSRI/SNRI
not for chronic use
selection of benzo is based on
pharmacokinetics
high potency benzos
alprazolam
clonazepam
benzos w. most rapid oral onset
clorzepate
diazepam
benzo w. most rapid IM absorption - most rapid and reliable
lorazepam
which benzos are used in acute setting
high potency → alprazolam, clonazepam
possible s.e of buspirone
EPS
__ is best for acute anxiety
__ is best for chronic anxiety
acute: high potency benzos → alprazoam, clonazepam
chronic → buspirone
buspirone must be administered __
and is not for __ use
routinely
prn
buspirone does not carry risk of
sedation
additive CNS dpn
retrograde amnesia
tolerance/withdrawal
how long does buspirone take to start working
2 weeks for anxiolytic
4-6 weeks for maximum effect
why aren’t barbituates used for anxiety
high abuse potential (class II)
lethality in od
ddi → via CYP450
first line tx for generalized anxiety disorder (gad)
SSRI or SNRI
CBT
2nd line meds
TCADs
benzos
buspirone
downside of TCADs
cardiotoxicity
downside of benzos
abuse
downsides of buspirone
longer time to onset
weaker anxiolytic
anxiety d.o with bb as first line tx
non generalized SAD (performance/social anxiety)
2nd line tx for SAD
rapid acting benzos → alprazolam/clonazepam
but significant risk of sedation
bb preferred for SAD
propranolol
tx for acute panic disorder
acute:
mild-mod:
severe:
acute: benzos
mild-mod: SSRIs, benzos, TCADs
severe: SSRIs/SNRIs PLUS CBT
for OCD tx, __ may be more effective
than __
CBT
meds
if you do use meds for OCD, what is first line
SSRIs
+/- SNRI
antipsychotic for refractory sx
pharm for severe OCD
SSRI
+/-SNRI
PLUS
CBT
t/f: for PTSD, pharm and CBT are equally effective
T!
what are positive sx of PTSD
arousal
flashback
nightmares
most effective pharm for positive sx of PTSD
alpha blockers
tx for PTSD:
first line:
severe:
first line: SSRIs
severe: SSRIs PLUS CBT
