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445- Pain and Mental Health > Anxiety > Flashcards

Anxiety Flashcards

1
Q

what is a common feature of anxiety disroders

A

presence of excessive fear and anxiety related to behavioural disturbances

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2
Q

what are panic attacks

A

a specific type of fear response

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3
Q

those with anxiety have higher prevalence of

A

CVD, GID, HPTN, arthritis, IBS< thyroid disease, respiratory disease, migraines and allergic conditions

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4
Q

emdian age of onset for anxiety is

A

30yrs

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5
Q

GAD peaks in _______ and declines with _____

A

middle age and declines with age

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6
Q

the excessive worry in GAB results in ________ and the expense of ____________

A

↓capacity to quickly + efficiently complete required tasks = expense of energy and time in state of worry

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7
Q

many pts with GAD say they have felt anxious and nervous _______

A

their whole lives- manifests into anxious temperment over time

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8
Q

course of GAD sx

A

wax and wane over lifespan- v low rates of full remission

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9
Q

which of the following is false about GAD
1. onset is rarely before adolescence
2. sx are chronic and wax and wane over lifetime
3. have low rates of full remission
4. most are on medication for short period of time to get over difficult situation

A

4

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10
Q

describe criteria A-C in GAD

A

excessive worry and anxiety, more days than not for 6mths about many things
finds it difficult to manage the worry
anxiety and worry associated with 3 or more of MRS.FICs (or 1 sx in children)

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11
Q

describe criteria D-F in GAD

A

anxiety causes clinically significant distress or impairment in social, occupational, or other important areas of funtioning
disturbance not due to something else
not better explained by another mental disorder

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12
Q

list 3 RF for anxiety

A

famHx for anxiety, personal hx of anxiety/ mood disorder, childhood stressful life events or trauma, female, chronic medical illness, behavioral inhibition

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13
Q

2 factors associated with GAD

A

childhood adversities, overprotective parenting

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14
Q

3 questions in GAD screening

A

In the past 4 weeks, are u bothered by feeling worried, tense, or anxious most of the time

Are you frequently tense, irritable, and having trouble sleeping

During the last 2 weeks, how much have you been bothered by: feeling nervous/ anxious/ frightened/ on edge, feeling panic/ benign frightened, avoiding situations that make you anxious

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15
Q

2 clinician rated anxiety rating scales

A

HAM-A
CGI scale

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16
Q

and increase on CGI-S and CGI-I means

A

worsening

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17
Q

2 pt rated anxiety scales

A

PHQ-9
GAD-7

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18
Q

what is the first line nonpharm option for GAD

A

psychotherapy

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19
Q

Evidence shows that_______________ have a benefit years later + continuous therapy can help maintain control of GAD

A

LT psychotherapy sessions

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20
Q

T or F: bright light therapy has some evidence of benefits in GAD

A

F

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21
Q

T or F: 1st line tx in GAD is combo psychotherapy + pharmacotherapy

A

F- financial strain
try monotx initially

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22
Q

which is true
1. psychotx > pharmacotx in GAD
2. psychotx = pharmacotx in GAD
3. psychotx < pharmaco tx in GAD

A

2

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23
Q

name the 1st line GAD pharmacotx

A

duloxetine, escitalopram, paroxetine, pregabalin, sertraline, venlafaxine

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24
Q

anxiolytisc bind _____ to various subtypes of ______

A

nonselectively
GABAa

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25
Q

a1 subunit binding =

A

sedation, ataxia, amnesia

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26
Q

which GABA subunit binding results in anxiolytic activity

A

a2 or a3

27
Q

what is a major pathway of metabolism for anxiolytics

A

phase 1

28
Q

in elderly pts with GAD, anxiolytics should be selected to

A

go through phase 2 metabolism

29
Q

whcih 3 anxiolytics go through phase 2 metabolism more than 1

A

lorazepam, oxazepam, temazepam

30
Q

phase 1 metabolism may be compromised by

A

disease states, age, CYPi

31
Q

a shorter half life of anxiolytics results in (SEs)

A

interdose withdrawal, anterograde amnesia, increased abuse potential

32
Q

longer anxiolytic half life SEs

A

handover effect

33
Q

Older adults have ↑ _________ + ↓ ________ of BZDs

A

sensitivity to
metabolism

34
Q

anxiolytics should be reserved for _____________ in older populations

A

severe GAD

35
Q

4 long acting anxiolytics

A

chlordiazepoxide, clorazepate, diazepam, flurazepam

36
Q

2 short acting anxiolytics

A

midazolam, triazolam

37
Q

T or F: PRN use of BZDs in GAD is preferred to avoid withdrawal/rebound effects

A

F- Short term, regular use may be better than PRN to avoid withdrawal/ rebound effects

38
Q

BZDs are associated with _______, _____,. ____________, and _______ anxiety between doses

A

dependence
tolerance
withdrawal rxns
rebound anxiety

39
Q

there is a greater rsk of sedation, dependence, memory impairment, rebound anxiety with _________ acting BZDs

A

short/ intermediate

40
Q

what is rebound after BZDs

A

occurs hrs-days after d/c where anxiety is similar or more intense than before

41
Q

describe the dependence/ tolerance effect of using BZDs- what kind of tolerance develops rapidly? what doesn’t?

A

rapidly = toelrance to sedative eff
does not occur, even after long usage = anxiolytic effect

42
Q

T or F: use of BZDs in GAD should be limited to avoid rapid development to anxiolytic effect

A

F- doesn’t develop tolerance to anxiolytic effect even after prolonged use
more common tolerance to hypnotic/ sedative

43
Q

when does withdrawal occur with SA and LA BZDs

A

SA = 1-2d
LA = 5-10d

44
Q

BZD withdrawal sx

A

insomnia, agitation, anxiety, perceptual changes, dysphoria, headaches, muscle aches, twitches, tremors, loss of appetite, diaphoresis, tachycardia, and GI distress

45
Q

dosage of BZDs should be gradually decreased over ______

A

6-12wks

46
Q

decrease BZDs by _____% of current dose q___d

A

10-20%
q3-7d

47
Q

in tapering down BZDs
1. we can use a LA BZD if patient was on SA to minimize withdrawal sx
2. the last 50% can be decreased faster than the first 50%
3. should be decreased gradually even if using low dose for short duration
4. may see withdrawal with LA at 1-2d

A

1

48
Q

buspirone MOA

A

central D2 agonist/ ant
5HT1A partial agonist
metabolite can increase NE release

49
Q

buspirone SEs

A

dizziness, lightheadedness, HA, nausea, sweating, nervousness

50
Q

T or F: buspirone causes lots of sedation

A

F- well tolerated, little sedation

51
Q

buspirone is a ____ substrate, and the metabolite is a _____ substrate

A

3A4
2D6

52
Q

the effect of buspirone may be seen ____ after taking routinely

A

2-4wks

53
Q

hydroxyzine’s activity at __, ___, ____ receptors in the brain produce the anxiolytic effects

A

M, 5HT, D

54
Q

hydroxyzine SEs

A

significant sedation, dizziness, QTc prolongation

55
Q

what is the active metabolite of hydroxyzine

A

cetirizine

56
Q

MAD medications should be titrated up in ___ intervals

A

1-2wk

57
Q

pharm tx is often associated with a delay of ____ in onset of sx relief, with full response taking up to ___wks or more

A

2-8wks
12wks or more

58
Q

what is considered remission in GAD

A

loss of dx, prespecified score on scale, no functional impairment

59
Q

what is considered response in GAD

A

25-50% reduction of sx on an appropriate scale

60
Q

T or F: there is no guideline algorithm for GAD

A

T

61
Q

how long to see full effect of pharm tx on GAD

A

8-12wks

62
Q

when should adjunctive agents be trialed for GAD

A

tx resistant GAD- trialed at least 2 1st line agents + failed

63
Q

what are 4 typical combos used with SSRIs/SNRIs in GAD

A

short term/ PRN BZDs
anticonvulsants
atypical antipsychotics
psychotx

64
Q

LT therapy is associated with continued symptomatic improvement + prevention of relapse = therapy should continue for at least _____ for most GAD pts

A

12-24mths

445- Pain and Mental Health (21 decks)

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