Anxiety Flashcards
Panic disorder time course
Allow 8-12 weeks for therapeutic response
Optimal duration unknown, 1-2 years recommended before gradual discontinuation over 4-6 months
What is first line for SAD?
SSRI (paroxetine, sertraline) or venlafaxine
- beta blocker 1 hour prior helps with symptoms
- not fluoxetine
- BZDs for failed treatment
What drugs can cause anxiety?
- Antidepressants early
- Steroids
- Stimulants
- Antibiotics
- HTN drugs
- Dopamine agonists
Benzodiazepines
For rapid relief of anxiety symptoms
- Lorazepam is good (especially in hepatic problems)
- May have paradoxical effect (irritability, aggression, excitation, impulsivity)
- Brief amnesia, sleep behaviors
- Different potencies but same effects at equivalent doses
- Taper to avoid withdrawal
a1 sedation
a2 anxiolysis
When should benzos be avoided?
- Substance abuse hx
- Myasthenia gravis
- Respiratory problems
- Pregnancy/lactation
- Elderly
What are the BBWs on benzodiazepines
- Abuse potential
- Physical dependence
- Increased death with opioids
Which benzos are approved for anxiety?
- Alprazolam
- Chlordiazepoxide
- Clonazepam
- Clorazepate
- Diazepam
- Lorazepam
Which benzos are approved for anxiety AND panic?
Alprazolam, Clonazepam
Clorazepate
Needs acid environment (prodrug)
More vs less lipophilic
More lipophilic drugs cross BBB easier (faster onset, shorter duration)
- More euphoria and misuse
Which benzos are less lipophilic?
Lorazepam, oxazepam
Which benzos are more lipophilic?
Diazepam (terrible, very misused), clorazepate
Which drugs have teratogenicity?
- Valproic acid
- Carbamazepine
- Lamotrigine
- Lithium
What should be avoided in panic disorder?
Buspirone
Specific phobia
Unresponsive to drug therapy - use CBT
- do NOT use benzos with CBT
- some evidence for BZD and paroxetine for failed CBT
Pregablin
GABA analog
- Not FDA approved for GAD
- Rhabdo possible
- AED warning for suicide
Buspirone
Non control, serotonin 1A
- FDA approved for GAD
- Takes a few weeks to work
Beta blockers
Propranolol, Atenolol
- Useful in tremor, inc HR
- Careful in CV
- 1 hour prior to events for SAD
PTSD
Paroxetine, Sertraline
do NOT use benzos
OCD
Fluvoxamine (its only use)
Fluoxetine, Paroxetine, Sertraline
What can treat PTSD nightmares?
Prazosin, clonidine
What can treat PTSD anger?
Lamotrigine
What can treat PTSD sleep issues?
Trazodone, clonidine
What can treat PTSD psychosis/flashbacks/dissociation/thoughts?
Risperidone, quetiapine
maybe olanzapine?
