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exam 4 > Anxiety > Flashcards

Anxiety Flashcards

1
Q

true or false: anxiety is the most commonly occurring psychiatric disorder

A

true

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2
Q

anxiety usually develops before the age of

A

30

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3
Q

is anxiety more common in men or women

A

women

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4
Q

What is anxiety

A

a normal and beneficial response to situations that are perceived as threatening, frightening, or disturbing. Becomes a disorder when it significantly impacts functioning

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5
Q

Drugs that cause anxiety (6)

A

Albuterol, caffeine, decongestants, levothyroxine, steroids, stimulants (ADHD meds)

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6
Q

what 6 medication classes may be used for anxiety?

A

Buspirone, BZDs, SSRIs, SNRIs, Hydroxyzine, herbal supplements

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7
Q

What kind of drug is buspirone?

A

serotonin (5HT)-1a receptor agonist

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8
Q

What specific anxiety disorder is treated by buspirone

A

generalized anxiety disorder (GAD)

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9
Q

The were two cons listed on the slides about buspirone….

A

often not dosed effectively and many patients and providers are skeptical of efficacy

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10
Q

Buspirone dose

A

10-15mg TID

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11
Q

what kind of interactions should we look for with buspirone

A

3A4 inducers and inhibitors

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12
Q

How long until we see efficacy from buspirone

A

3-4 weeks for initial efficacy

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13
Q

Which 4 BZDs are used for anxiety

A

alprazolam, lorazepam, clonazepam, diazepam

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14
Q

Why don’t guidelines support the use of BZDs for anxiety

A

misuse potential of BZDs

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15
Q

are BZDs or SSRIs more effective for anxiety according to studies

A

BZDs

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16
Q

How are BZDs dosed incorrectly in practice?

A

Usually given PRN so it doesn’t work well for anxiety

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17
Q

Should BZDs be used long-term or short term?

A

short term, may cause dependence or tolerance

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18
Q

Acute withdrawal of BZDs may lead to what?

A

life-threatening seizures

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19
Q

there are warning of prescribing BZDs for anxiety with ____ because of increased overdose death risk

A

opioids

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20
Q

BZDs with active metabolites have a higher ___ ___

A

fall risk

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21
Q

Which BZDs do not have active metabolites?

A

alprazolam, lorazepam, clonazepam, oxazepam

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22
Q

there are 3 BZDs that have a long acting active metabolite that increase risk for fall, especially in elderly

A

diazepam, clorazepate, and chlordiazepoxide

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23
Q

Side effects of BZDs (5)

A

sedation, paradoxical excitement, swallowing difficulties, impaired memory/recall, and psychomotor impairment

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24
Q

Can you discontinue BZDs immediately?

A

No, they must be tapered

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25
Q

BZDs and Beers criteria

A

usually considered inappropriate in elderly due to fall risk and paradoxical rxn

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26
Q

Which BZDs would we prefer in elderly?

A

Prefer LOT, lorazepam, oxazepam, and temazepam (short acting without active metabolites)

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27
Q

What specific type of anxiety is Hydroxyzine Pamoate FDA approved for?

A

generalized anxiety disorder (GAD)

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28
Q

Why would we use Hydroxyzine pamoate HCL salt over Hydroxyzine?

A

so the patient can take a dose that’s 10mg lower

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29
Q

How is hydroxyzine taken for anxiety and sleep

A

prn, especially if history of substance abuse

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30
Q

usual dose of hydroxyzine

A

25mg-50mg TID, usually at bedtime

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31
Q

What does hydroxyzine work on

A

serotonin 5HT2A antagonist and H1 receptor antagonist

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32
Q

Side effects of hydroxyzine (3)

A

sedation, QTc prolongation, anticholinergic side effects

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33
Q

Hydroxyzine and beers criteria

A

not recommended for use in elderly patients do to fall risk and anti-cholinergic side effects

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34
Q

how does propanolol help anxiety

A

decreases the physiological symptoms associated with anxiety like tachycardia, sweating, and flushing

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35
Q

what kind of anxiety is propanolol most helpful for

A

performance and situational anxiety (PRN)

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36
Q

dose of propanolol

A

low doses, 10-20mg BID/TID

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37
Q

What in a pts med history should be evaluated before prescribing propanolol

A

hx of asthma and CVD conditions

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38
Q

cons of propanolol for anxiety

A

may mask hyperglycemia and make depression worse

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39
Q

5 natural products used for anxiety

A

Kava, St Johns Wort, Passionflower, Valerian, Chamomile

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40
Q

Is Gabapentin and pregabalin FDA approved for anxiety

A

No, but they are still occasionally prescribed

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41
Q

Pts who have ____ and ____ with anxiety may be prescribed gabapentin or pregabalin

A

bipolar disorder and neuropathic pain

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42
Q

What condition besides anxiety is quetiapine usually prescribed for?

A

sleeplessness

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43
Q

should quetiapine be used for insomnia

A

“sleep medicine does not endorse the use of quetiapine for insomnia”

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44
Q

6 types of anxiety

A

generalized anxiety
panic disorder
social anxiety
obsessive compulsive disorder
ptsd
anxiety associated with other medical conditions

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45
Q

Drugs that induce anxiety

A

cocaine, beta agonists, caffeine, corticosteroids

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46
Q

what is the fear center of the brain and which neurotransmitter effects it

A

amygdala, norepinephrine

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47
Q

what neurotransmitter counteracts GABA

A

glutamate

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48
Q

what neurotransmitter does GABA counteract

A

norepinephrine

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49
Q

what does glutamic acid decarboxylase do?

A

converts glutamate to GABA in the CNS

50
Q

What kind of drug is beneficial at 5HT1a serotonin receptors (agonist, antagonist, inverse agonist, partial agonist)

A

partial agonist

51
Q

Duration and onset of BZDs for anxiety

A

quick onset, very effective

52
Q

Onset of SSRIs, SNRIs, and other antidepressants for anxiety

A

take 2-4 weeks for onset of effects

53
Q

benefits of ketamine for anxiety

A

nasal spray, very quick acting

54
Q

what kind of drug is buspirone and what receptor does it act on

A

partial agonist, 5HT1a receptor

55
Q

buspirone onset of action compared to BZD

A

longer onset of action

56
Q

what are the benefits of Buspirone

A

low abuse potential, little to no withdrawal

57
Q

Would you choose BZDs or Buspirone for panic disorders? Why?

A

I would choose BZDs, faster onset of action

58
Q

Side effects of propanolol for anxiety

A

hallucinations, vivid dreams, lethargy, impotence

59
Q

What must you do for the initial dose of propanolol

A

may need to test dose initially

60
Q

what receptor does hydroxyzine work on

A

histamine H1 antagonist

61
Q

Clonidine receptor target

A

alpha 2 agonist

62
Q

what two kinds of anxiety does clonidine treat

A

panic attacks and anxiety associated with withdrawal

63
Q

what is the receptor target of ondansetron

A

5HT3

64
Q

what is the receptor target of Ketanserin

A

5HT2

65
Q

Tiagabine blocks the uptake of what

A

GABA uptake blocker

66
Q

target of d-cycloserine and memantine

A

NDMA receptor

67
Q

LY354740 target

A

mGluR2/3 agonist

68
Q

fenobam target

A

mGluR5

69
Q

What is the first line agent for all kinds of anxiety

A

SSRIs and SNRIs

70
Q

what kind of antipsychotics are approved for anxiety and treatment resistant OCD

A

atypical antipsychotics like aripiprazole and risperidone

71
Q

What is generalized anxiety disorder

A

excessive anxiety/worry around a number of life events that is difficult to control

72
Q

How long does anxiety have to be present to be classified as GAD?

A

at least 6 months

73
Q

Do be classified as GAD, pt must have at least 3 symptoms including (7)

A

restlessness/feeling keyed up or on edge
being easily fatigued
difficulty concentrating
irritability
muscle tension
sleep disturbances

74
Q

What is the first line therapy for GAD

A

SSRI antidepressants

75
Q

What two SSRIs are approved for GAD

A

Paroxetine and escitalopram

76
Q

SNRIs are a useful first line if patient also has what?

A

pain syndrome

77
Q

What drug class can be used as a bridge therapy before SSRIs/SNRIs kick in

A

BZDs

78
Q

What medication can be used prn for anxiety or symptoms of anxiety

A

hydroxyzine

79
Q

What is social anxiety disorder

A

persistent fear about social and or performance situations in which the patient fears embarrassment or humiliation that is unreasonable

80
Q

non pharm options for social anxiety disorder

A

avoid the specific situations

81
Q

Duration of symptoms for social anxiety disorder

A

at least months

82
Q

approved SSRIs for Social anxiety disorder

A

paroxetine and sertraline

83
Q

approved SNRI for social anxiety disorder when SSRIs fail

A

venlafaxine

84
Q

What class of drug may be useful for non-generalized performance related Social anxiety disorder

A

Beta-blockers

85
Q

what drug is used for treatment resistant SAD

A

phenelzine

86
Q

What is panic disorder

A

recurrent, unexpected panic attacks

87
Q

what is an abrupt surge of intense fear or discomfort that reaches a peak in minutes and is accompanied by at least 4 physical and psychological symptoms

A

panic disorder

88
Q

what symptoms are seen in panic disorder (7)

A

sweating, palpitations, nausea, dizziness, fear of losing control, going crazy, or dying

89
Q

What is agoraphobia

A

fear of places that may cause panic or anxiety

90
Q

true or false, panic disorder is characterized by at least one attack followed by one month or more of concern of attack or change of behavior related to attack

A

true

91
Q

what is first line treatment for panic disorder

A

SSRIs

92
Q

Which SNRI is approved for treatment of panic disorder

A

Venlafaxine

93
Q

What is the recommendation for BZDs in panic disorder

A

should not be first line therapy unless there is an inadequate response to serotonin drugs

94
Q

which BZDs are FDA approved for panic disorder

A

alprazolam and clonazepam

95
Q

what does bridge therapy mean?

A

using benzodiazepines for panic attacks until SSRIs kick in.

96
Q

What are obsessions

A

recurrent thoughts or images that are intrusive and cause anxiety, patient attempts to ignore but cannot

97
Q

what are compulsions

A

repetitive behaviors in response to obessions

98
Q

what are the two components of OCD

A

obsessions and compulsions

99
Q

what can be expected by treatment of OCD

A

25-50% reduction in symptoms

100
Q

what is the first line treatment for OCD

A

SSRIs

101
Q

What is the second line therapy for OCD if patient fails SSRIs

A

Clomipramine (TCA)

102
Q

Clomipramine’s only indication is

A

OCD

103
Q

Can antipsychotics be used in OCD

A

not FDA approved, may be used for augmentation therapy with SSRIs/SNRIs

104
Q

SSRIs and SNRIs can be used with what drug class to help OCD

A

antipsychotics

105
Q

Which antipsychotic is best for OCD

A

Risperidone

106
Q

which drug is inconsistently effective for OCD

A

Aripiprazole

107
Q

what is PTSD

A

exposure to real or threatened death, serious injury, or sexual violence

108
Q

what are four components of PTSD

A

flashbacks, reexperiencing, avoidance, hypervigilance

109
Q

negative alterations in mood or cognition is a component of PTSD

A

true

109
Q

what is the first line agent for PTSD

A

SSRIs/SNRIs

110
Q

what drug is helpful for sleep or nightmares in PTSD patients

A

prazosin

110
Q

What drug class is not recommended for PTSD

A

BZDs

111
Q

Monotherapy usually works for PTSD

A

false

112
Q

what is often a result of PTSD

A

substance use

113
Q

what non-pharm options are beneficial for PTSD

A

CBT and eye movement desensitization and reprocessing

114
Q

where in the brain is the focus of PTSD and what neurotransmitter is involved

A

norepinephrine in the amygdala

115
Q

Is there any prevention for PTSD

A

not really

116
Q

SSRIs and SNRIs may cause what syndrome

A

Jitteriness syndrome

117
Q

how do you avoid jitteriness syndrome with SSRIs and SNRIs

A

initial dose should be lower than doses used for depression and follow up appropriately

118
Q

In PTSD, drug therapy is more effective in combat trauma compared to civilian trauma

A

false, more effective in civilian trauma because it is usually a one-time event

exam 4 (7 decks)

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