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pharmacy 358 > Anxiety > Flashcards

Anxiety Flashcards

1
Q

What part of the brain handles fear?

A

amygdala to prefrontal

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2
Q

What part of brain handles worry?

A

cortico-striato-thalamo-cortical circuit

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3
Q

What general neurotransmittes are involved in fear?

A

serotonin, GABA, glutamate

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4
Q

What neurotransmitter is dominant in the pathway of worry?

A

dopamine

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5
Q

How are sodium channels involved with neurotransmitters and associated drugs?

A

gabapentin/pregabalin block release of glutamate

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6
Q

What is buspirone’s MOA compared to SSRI?

A

5-HT1A agonist and this is similar to antipsychotics

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7
Q

What is the reason for doctors wanting buspirone for immediate anxiety relief?

A

NONE just as slow as AD
if want speed use benzos

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8
Q

Since we know norepinephrine can cause flight or fight, how does SNRI’s actually help anxiety?

A

worsen at beginning but eventually beta receptors are down regulated

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9
Q

How can we limit nightmares and how do they occur?

A

alpha 1 stimulation
prazosin can block

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10
Q

What OTC/ commercial drugs can mimic anxiety?

A

decongestant, caffeine

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11
Q

GENERAL First line meds for GAD?

A

SSRI,SNRI, pregabalin

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12
Q

If a patient has anxiety and seizure which medication should we avoid?

A

bupropion

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13
Q

When should buspirone not be used?

A

comorbid depression

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14
Q

Which SSRI has less insomnia, agitation and DI?

A

citalopram

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15
Q

Which anxiety med are we concerned with QTc?

A

citalopram

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16
Q

When would duloxetine be an interesting add for anxiety?

A

comorbid pain

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17
Q

Which SSRI is most activating?

A

fluoxetine

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18
Q

Which medications can cause withdrawal?

A

SNRI

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19
Q

Why does fluvoxamine suck?

A

DI- CYP1A2 2C19

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20
Q

When is hydroxyzine an good add?

A

comorbid insomnia

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21
Q

When is mirtazipine helpful?

A

sleep

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22
Q

Issues with mirtazapine?

A

weight gain, appetite

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23
Q

Issues with paroxetine?

A

most sedating of SSRI, lots of weight gain, DI

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24
Q

Issues with sertraline?

A

more insomnia, agitation, dizziness than other SSRI

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25
Q

Which medications have issues with sex dysfunction?

A

SSRI-NOT sertraline
SNRI- Venlafaxine, duloxetine

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26
Q

What medication withdrawal can mimic GAD?

A

alcohol, sedatives, benzos

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27
Q

What antidepressant is best known to be prone to cause anxiety?

A

bupropion

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28
Q

What other medications can cause GAD sx?

A

CS, stimulants

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29
Q

Sx of anxiety?

A

worry, poor concentration, restless, irritable, issues with sleep, fatigue

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30
Q

What scale can we use in practice to assess anxiety?

A

GAD-7

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31
Q

Non pharm for anxiety?

A

exercise, reduce caffeine, CBT, relaxation

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32
Q

How good is CBT therapy?

A

comparable to drugs

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33
Q

Which of the SSRI’s and SNRIs are first line for GAD?

A

SSRI- paroxetine, sertraline, escitalopram
SNRI- duloxetine, venlafaxine
PREGABALIN

34
Q

What is 2nd line for GAD?

A

Benzo- short term= alpraz, lorazepam, diazepam
bupropion
buspirone
hydroxyzine

35
Q

Patient has GAD and old what option?

A

Escitalopram or sertraline

36
Q

Patient has GAD and insomnia?

A

pregabalin or hydroxyzine

37
Q

Patient pregnant and GAD?

A

NO benzo or paroxetine

38
Q

Patient has GAD and bipolar mania?

A

quetiapine

39
Q

Patient has GAD and bipolar depression?

A

pregabalin

40
Q

What anxiety condition will probably utilize prazosin?

A

PTSD

41
Q

When to see effect of buspirone?

A

2 weeks or LONGER

42
Q

Why are antipsychotics not used in GAD?

A

bad s/e

43
Q

AT what dose is venlafaxine more NE?

A

> 150

44
Q

When to see improve of GAD and when at max, and duration?

A

Improve in2-4 weeks
max at 12 weeks
duration 1-2 years

45
Q

When is benzos role useful?

A

anticipate acute attack

46
Q

Although no evidence of clonazepam in GAD, why use?

A

longer half life and avoids peaks and troughs

47
Q

Why not use alprazolam?

A

SUPER short duration

48
Q

Benefits of clonazepam and diazepam?

A

longer half life

49
Q

When to use lorazepam?

A

haptic issues

50
Q

s/e of benzos?

A

ataxia, dizzy, sedation or even insomnia, depression

51
Q

What benzos are better in elderly?

A

LOT
lorazepam
oxazepam
temazepam

52
Q

What are signs of benzo withdrawal?

A

seizures, sweat, tremor, NV, anxiety

53
Q

What is the antidote for benzos? Why is it not used often?

A

flumazenil
causes seizures

54
Q

Why is venlafaxine not good in elderly?

A

HTN

55
Q

Criteria for Panic disorder?

A

4 of palpitations, sweaty, tremble, N

56
Q

What is the difference between panic attack and disorder?

A

attack- 4 or more sx come on suddenly and peak at 10 min
disorder-recurrent of at least 1 attack and a month of worrying of another attack

57
Q

Which SSRI has more gi issues?

A

sertraline

58
Q

What is first line for PD?

A

same as Gad just no pregabalin and add fluoxetine

59
Q

What is second line for PD?

A

TCA (clomipramine and imipramine), BZD

60
Q

When to get remission in PD?

A

6 months

61
Q

When should we think of switching medications if not working in PD?

A

6-8 weeks

62
Q

What is the working theory around Social Anxiety disorder?

A

DOPAMINE Dfx

63
Q

How long must you have social anxiety to be diagnosed?

A

6 months

64
Q

What’s the difference between generalized and not SAD?

A

generalized= all situations
non- a few

65
Q

What is first line for SAD?

A

CBT, SSRI, SNRI, pregabalin

66
Q

What can we give for performance anxiety and who are contraindicated?

A

atenolol, propanolol- asthma severe bronchorestriction

67
Q

SNRI or SSRI for SAD?

A

SSRI first

68
Q

What are the 6 stages of PTSD?

A

freeze, flight, fight, fright, flag, faint

69
Q

What happens with long term stress or high stress situations?

A

breaks down ability for brain to consolidate memories

70
Q

What are criteria for PTSD?

A

experience
reexperience
avoidance

71
Q

What is nonpharm for PTSD?

A

TAILORED on trauma focused psychotherapy

72
Q

What first line for PTSD?

A

Fluoxetine, paroxetine, sertraline
venlafaxine
prazosin

73
Q

What drugs are NOT recommended in PTSD? WHY?

A

BENZOS
- no efficacy and more harms

74
Q

Which SSRI has most sex dysfunction?

A

sertraline

75
Q

When to see onset, max response and duration for PTSD?

A

onset 2-8 weeks
max-12 weeks
duration 1-2 years

76
Q

What is diagnosis of OCD?

A

recurrent thoughts and urges
behaviours to prevent or reduce anxiety

77
Q

What can cause OCD?

A

genetic, streptococcal infection
pregnancy, abuse

78
Q

What is first line for OCD?

A

SSRI (escitalopram, fluoxetine, paroxetine, sertraline) for minimum 12 weeks and CBT for 13 sessions

79
Q

What other Nonpharm for OCD?

A

deep brain stimulation- severe
radio frequency wave surgery- refractory

80
Q

Which is CBT better for obsessions or compulsions?

A

compulsions

81
Q
A

pharmacy 358 (12 decks)

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