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PHRM 845: Therapeutics III > Anxiety > Flashcards

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
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2
Q

What are some of the drugs that can cause Anxiety?

A
  • Albuterol, Caffeine [High Dose], Decongestants, Levothyroxine, Steroids, Stimulants
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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
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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
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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
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6
Q

Which one of the benzodiazepines DO NOT have an active metabolite in Anxiety?

A
  • Alprazolam, Lorazepam, Clonazepam, Oxazepam
  • Still HIGH fall risk
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7
Q

Which one of the benzodiazepines HAVE an active metabolite in Anxiety?

A
  • Diazepam, Clorazepate, Chlordiazepoxide
  • Leads to hangover and falling
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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
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9
Q

How should benzodiazepines be used in elderly patients with Anxiety?

A
  • Maybe inappropriate
  • Prefer LOT: Lorazepam, Oxazepam, Temzaepam
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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]
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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
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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
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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
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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
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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
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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
Q

What is the treatment of Post-Traumatic Stress Disorder?

A
  • 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
Q

What are some of the selected drug therapy ISSUES in Anxiety?

A
  • 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
Q

What are some of the non-pharmacologic treatment options for Anxiety Disorder?

A
  • 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
Q

What are the types of anxiety?

A
  • Generalized Anxiety Disorder [GAD]
  • Panic Disorder
  • Social Anxiety Disorder
  • Obsessive-Compulsive Disorder [OCD]
  • Post-Traumatic Stress Disorder [PTSD]
29
Q

What are some of the Drugs that induce Anxiety?

A
  • Cocaine, Beta-Blockers, Caffeine, Corticosteroids, Stimulants, Levothyroxine, Decongestants
30
Q

What is the main target for treating Anxiety?

A
  • Norephinephrine: too much released
  • Could project over to the Amygdala - fear!
31
Q

What does the GABAergic System do within Anxiety?

A
  • Normally counteracts the effects of excess NE [Maybe a reduction in GABAergic signaling]
  • Increase in GABAergic may help treat anxiety
32
Q

How does Glutamate get converted into GABA?

A
  • Glutamate gets converted into GABA by glutamate acid decarboxylase -> GAD in the CNS
33
Q

How does Serotonin affect anxiety?

A
  • Maybe affects the Amygdala and the balance of NE
  • May mimic SSRIs
34
Q

What are some of the medications that are used in the treatment of Anxiety?

A
  • Benzodiazepines [Quick acting, effective]
  • Antidepressants [SSRIs/SNRIs - long acting]
  • Ketamine [VERY quick acting]
  • Buspirone
  • Beta-Blockers

PHRM 845: Therapeutics III (25 decks)

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