Anxiety Flashcards
1
Q
What is the epidemiology of Anxitey?
A
- MOST COMMON OCCURRING
- Develops before 30 years old
- Women > Men
- Normal response to threatening frightening or disturbing events
- Disorder when it impact functioning
2
Q
What are some of the drugs that can cause Anxiety?
A
- Albuterol, Caffeine [High Dose], Decongestants, Levothyroxine, Steroids, Stimulants
3
Q
What are some of the medication that we can use to help treat someone with Anxiety?
A
- Buspirone, Benzodiazepine, SSRIs, SNRIs, Hydroxyzine, Herbal Supplements
4
Q
What is the way that Buspirone is used in treatment of Anxiety?
A
- Serotonin [5HT1A] agonist
- Approved for generalized anxiety disorder
- Should be dosed with a target of 10-15mg x3 daily
- May take up to 3 - 4 weeks for initial efficacy
5
Q
What is the way that Benzodiazepines are used in treatment of Anxiety?
A
- Should NOT use regularly due to ABUSE, but they have a greater efficacy than SSRIs [Long term use not recommended]
- Acute withdrawal is bad too [life-threatening seizures] - D/C is a slow taper over weeks to months
- WARNING with combo with other CNS depressants
6
Q
Which one of the benzodiazepines DO NOT have an active metabolite in Anxiety?
A
- Alprazolam, Lorazepam, Clonazepam, Oxazepam
- Still HIGH fall risk
7
Q
Which one of the benzodiazepines HAVE an active metabolite in Anxiety?
A
- Diazepam, Clorazepate, Chlordiazepoxide
- Leads to hangover and falling
8
Q
What are some of the side effects associated with benzodiazepines in Anxiety?
A
- SEDATION, paradoxical excitement, swallowing difficulties, impairment of memory and recall, psychomotor impairment
9
Q
How should benzodiazepines be used in elderly patients with Anxiety?
A
- Maybe inappropriate
- Prefer LOT: Lorazepam, Oxazepam, Temzaepam
10
Q
What is the way that Hydroxyzine is used in treatment of Anxiety?
A
- FDA Approved in generalized anxiety disorder
- AS NEEDED for anxiety or insomnia [instead of benzo]
11
Q
What are some of the side effect of Hydroxyzine in Anxiety?
A
- Sedation, Anticholinergic [Dry Mouth, Constipation, Urinary Retention, Blurred Vision], QTc prolongation
- AVOID: in elderly
12
Q
What is the way that Propranolol is used in treatment of Anxiety?
A
- Helps with acute anxiety
- Useful in Performance and situational anxiety
- Low Doses [10mg or 20mg two to three times daily]
- AVOID: if history/current asthma and/or cardiovascular condition
13
Q
What are some of the natural products that are used in Anxiety?
A
- Kava: Hepatotoxicity/Liver Failure [NO]
- St. Johns Wart: Strong 3A4 inducer [DRUG INTERACTIONS}
- Passionflower: Dizziness, ataxia, confusion
- Valerian: similar to Benzo’s; AVOID in pregnancy
- Chamomile
14
Q
What is the way that Gabapentinoids & Quetapine is used in Anxiety?
A
- Gabapentinoids: Considered for Bipolar disorder who HAS anxiety symptoms or neuropathic pain
- Quetiapine: Used for both anxiety and sleep
15
Q
What are some of the general drug therapy principles for Anxiety?
A
- SSRIs & SNRIs are first line for ALL anxiety disorders
- Buspirone is first line for generalized anxiety disorder
- Benzodiazepines are FDA-approved to treat anxiety, BUT only PRN
16
Q
How does the DSM-5 describe Generalized Anxiety Disorder?
A
- Excessive anxiety/worry what lasts for least 6 months
Symptoms [Need 3 of the following] - Restlessness, Feeling on edge, Fatigued, Difficulty Concentrating, Irritability, Muscle Tension, Sleep Disturbances
17
Q
What are some of the treatments for Generalized Anxiety Disorder?
A
- First line: SSRI antidepressants [take 2-4 weeks]
- SNRI antidepressants MIGHT be useful [used if in PAIN]
- Benzodiazepines: “Bridge Therapy” to help with the onset of the SSRIs/SNRIs; MUST TAPER is long term use
- Buspirone: Need high dose and how long to work
- Hydroxyzine: AS NEEDED for anxiety
18
Q
How does the DSM-5 Describe Social Anxiety Disorder?
A
- Persistant fear about social and/or performance situation in which the patient fears embarrassment or humiliation that is unreasonable
- Symptoms lasts 6 month
19
Q
What is the treatment of Social Anxiety Disorder?
A
- First Line: SSRI [Paroxetine, Sertraline]
- SNRIs: Maybe is SSRIs fail [Venlafaxine]
- Beta-Blockers: Non-generalized, performance-related SAD
20
Q
How does the DSM-5 describe Panic Disorder?
A
- Recurrent, unexpected panic attacks
- At least one attack has been followed by one month or more of at least one of the following: CONCERN ABOUT ATTACKS OR BEHAVIOR CHANGES
21
Q
What is the treatment of Panic Disorder?
A
- First line: SSRIs
- SNRIs: Venlafaxine is FDA-approved
- Benzodiazepines: NOT first line unless SSRIs/SNRIs dont work
22
Q
How does the DSM-5 describe Obsessive-Compulsive Disorder?
A
- Obsession: recurrent thoughts or images that are intrusive and anxiety causing
- Compulsion: repetitive behaviors or mental acts performed in repose to the obsession
23
Q
What is the treatment of Obsessive Compulsive Disorder?
A
- First line: SSRIs [25-50% reduction in symptoms]
- TCA: clomipramine [MORE SEROTONERGIC TCA for OCD]
- Antipsychotics: NOT APPROVED [maybe add on to SSRIs/SNRIs]; Risperidone is most effective & Aripiprazole is inconsistent efficacy
24
Q
How does the DSM-5 describe Post-traumatic Stress Disorder?
A
- Exposure to real or threatened death, serious, or sexual violence [either victim, witness, dicovery, exposure to details of traumatic event]
- Flashback, Re-experiencing, Avoidance, Hyper-vigilance
25
What is the treatment of Post-Traumatic Stress Disorder?
- First Line: SSRIs/SNRIs; FDA-apporved
- Prazosin: maybe helpful for sleep and nightmares
- Benzodiazepines: NOT RECOMMENDED
- Polytherapy and Substance use is common
- Cognitive behavioral therapy and eye movement desensitization and reprocessing
26
What are some of the selected drug therapy ISSUES in Anxiety?
- Jitteriness syndrome can result from SSRIs/SNRIs [minimized by lower than initial dose]
- Onset of action: SSRIs/SNRIs is 2-4 weeks
- Evaluate severity of anxiety before using "bridge therapy" with benzodiazepines [abrupt D/C is life-threatening]
27
What are some of the non-pharmacologic treatment options for Anxiety Disorder?
- Psychotherapy and Cognitive behavioral therapy
- IN PTSD: drug therapy may be more effectie in civilian trauma VS combat trauma; SO non-drug treatments are useful
28
What are the types of anxiety?
- Generalized Anxiety Disorder [GAD]
- Panic Disorder
- Social Anxiety Disorder
- Obsessive-Compulsive Disorder [OCD]
- Post-Traumatic Stress Disorder [PTSD]
29
What are some of the Drugs that induce Anxiety?
- Cocaine, Beta-Blockers, Caffeine, Corticosteroids, Stimulants, Levothyroxine, Decongestants
30
What is the main target for treating Anxiety?
- Norephinephrine: too much released
- Could project over to the Amygdala - fear!
31
What does the GABAergic System do within Anxiety?
- Normally counteracts the effects of excess NE [Maybe a reduction in GABAergic signaling]
- Increase in GABAergic may help treat anxiety
32
How does Glutamate get converted into GABA?
- Glutamate gets converted into GABA by glutamate acid decarboxylase -> GAD in the CNS
33
How does Serotonin affect anxiety?
- Maybe affects the Amygdala and the balance of NE
- May mimic SSRIs
34
What are some of the medications that are used in the treatment of Anxiety?
- Benzodiazepines [Quick acting, effective]
- Antidepressants [SSRIs/SNRIs - long acting]
- Ketamine [VERY quick acting]
- Buspirone
- Beta-Blockers
