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
