Anxiety Flashcards
SAD def
chronic, long-term illness requiring extended therapy. after improvement at 8 weeks, continue tx for 6-12 months
SAD first line options
SSRIs or venlafaxine
brain regions in anxiety
anygdala
LC-locus ceruleus
hypothalamus
ntms in anxiety
NE, GABA, 5HT, CRF, cholecystokinin
GAD s/sx
dx
excessive anxiety, worries difficult to control, feeling on edge, poor concentration, mind going blank
restlessness, fatigue, muscle tension, sleep disturbances, irritability
sx are unrealistic and or excessive
persistent sx for most days for at least 6 months
drugs that can induce anxiety
anticonvulsants, ADs, BP meds, ABX, bronchodilators, CS, DA ag, herbal agents, illicit substances, stimulants, toxicity, w/drawal
GAD
SNRIs
SSRIs
can use vs FDA approved
duloxetine, venlafaxine XR can use and FDA approv
escitalopram, paxil, zoloft - can use
zoloft - not FDA-ap
GAD 2nd, 3rd line
2nd = hydroxizine or change AD
3rd = quetiapine XR, divalproex
can do benzo (chlordiazepoxide, clorazepate, lorazepam, alprazolam, diazepam)
benzos in liver dysfunction
LOT
lorazepam
oxazepam
temazepam
PD s/sx
fear of losing control, going crazy, and dying
depersonalization
de-realization
abdominal distress/pain
chest pain, discomfort
chills/hot flashes
SOB
trembling/shaking
sweating
agoraphobia
agoraphobia
anxiety about being in at least 2 situations or places where escape is difficult or help unavailable
may be secondary to panic attack but panic attack may be never experienced
panic disorder AD onset
8-12 weeks for full effect, 4 weeks to see anti-panic effect
non-pharm options for PD
CBT
psychosocial tx psychoeducation
avoid stimulants and alcohol
inc physical activity
high potency benzos are ______ over benzos that need high doses
which benzos are for each
preferred
high pot = alprazolam and clonazepam
high dose IM = lorazepam and diazepam
A. patient e PD starts taking fluoxetine
after 12 weeks response is inadequate
options?
B. same patient, after 12 weeks of taking the therapy recommended in part A there is an inadequate response.
options?
C. same patient, failed second option from part B. options?
at any step, if response is adequate, how long should therapy be continued for?
change SSRI to paroxetine or sertraline
change to venlafaxine
change SSRI
change to venlafaxine
add BZD or gabapentin or atypical AP
continue for 12-24 months
when dc med for PD, how long should discontinuation take
6 months
BZD should or should not be used in pts doing CBT? Why?
should NOT
you want pt to be fully present and at their normal baseline
SAD s/sx
tachycardia, flushing, sweating, phobic avoidance, social anxiety
how long is SAD tx acute phase, continuation phase and maintenance phase
4-12 weeks
3-6mo
6 mo+
FDA approved not approved meds for SAD
approved: paroxetine, sertraline, venlafaxine
not approv: fluvoxamine, escitalopram, pregabalin, gabapentin
SAD: what is used for acute performance sx management
BBs: propranolol and atenolol
SAD: what to avoid in pregnancy
avoid paroxetine and benzos
when is CBT recommended in SAD
at any time w or w out tx
not to be done if pt is on benzos
FDA approved for OCD
paroxetine, fluoxetine, fluvoxamine, sertraline
when is clomipramine used in OCD
when pt fails SSRI due to ADR
when can you augment with APs in OCD
when patient has failed three different medications, one of them being clomipramine
when can pt be tapered off medication for OCD
after 1-2 years
