Anxiety Flashcards
1
Q
Occasional vs Anxiety Disorder
A
- Occasional anxiety: short-term anxiety that passes over time
- Anxiety disorder: chronic and severe sxs that causes significant distress and reduce QoL
2
Q
Types of Anxiety Disorders
A
- Generalized Anxiety Disorder (GAD)
- Panic Disorder (PD)
- Social Anxiety Disorder (SAD)
3
Q
Disorders with Anxiety Sxs
A
- Obsessive Compulsive Disorder (OCD)
2. Post-traumatic stress disorder (PTSD) - veterans, school shootings, etc.
4
Q
Non-Drug Tx
A
- Avoid drugs that worsen anxiety
- CBT
- Lifestyle changes
- Comorbid conditions - depression
5
Q
Drugs that Cause Anxiety
A
- Albuterol (used to freq.)
- Antipschotics
- Bupropion (big SE)
- Caffeine (high doses)
- Decongestants (stimulants)
- Illicit drugs (cocaine, meth)
- Levothyroxine
- Steroids
- Stimulants (amphetamine, methylphenidate)
- Theophylline - converted to caffeine at high doses (narrow therapeutic range)
6
Q
Natural Product Options
A
- Kava (liver damage)
- 5-HTP - eosinophilia myalgia syndrome
- L-tryptophan - eosinophilia myalgia syndrome
- St. John’s wort - strong CYP3A4 inducer, serotonergic syndrome, photosensitive
- Valerian - used for insomnia and anxiety (liver damage)
- Passionflower - possibly effective!
7
Q
First Line Anxiety Tx
A
- SSRIs and SNRIs
- Start low and slow
- Takes at least 4 weeks to see benefit
8
Q
2nd Line for Anxiety
A
- Buspirone: specific recommendation for anxiety (2-3 weeks to see benefit)
- TCAs: antichol. SE
- Hydroxyzine: sedating antihistamine
- Pregabalin: used for anxiety and neuropathic pain
9
Q
Inderal
A
- Propranolol
- Specifically used for stage fright
- B-blocker reduces tachycardia, tremor, sweating
10
Q
Benzos
A
- Short-term ONLY
- Many SE: somnolence, dizziness, ataxia
- Enhance GABA: major inhibitory neurotransmitter
- ALL CIV drugs
- Dependence issue requires them to be tapered slowly
- Beer’s Criteria!
11
Q
Buspirone
A
- Not a controlled substance
- No abuse/dependence potential
- Switching from BZD to buspirone? Taper BZD slowly!
- Avoid use with MAOI and CYP3A4 inhibitors (grapefruit)
12
Q
What meds are connected to MAOI avoidance?
A
- Linezolid
- Methylene blue
- *Usually avoid these along with MAOI**
13
Q
Safe Use of BZD
A
- LOT meds are safer in older pts: Lorazepam, oxazepam, temazepam
- “Un-do anxiety with UN-CLAD” - clonazepam (long half life, less abuse/withdrawal risk), lorazepam, alprazolam (fast and abuse potential), diazepam (long half life but fast, abuse potential)
- Antidote: flumazenil
14
Q
BZD: Sleep Indications
A
- Lorazepam
- Temazepam
15
Q
BZD: Seizure
A
- Diazepam
- AKA Diastat AcuDial
- Rectal gel
- Any IV BZD can also be used
