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Therapeutics 3 > Anxiety > Flashcards

Anxiety Flashcards

1
Q

What medications can cause anxiety?

A

-anticonvulsants
-antihypertensives
-BRONCHODILATORS
-dopamine agonists (ILLICIT SUBSTANCES)
-STIMULANTS
-LEVOTHYROXINE

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2
Q

What is first line therapy for generalized anxiety disorder(GAD)?

A

SSRI/SNRI or anticonvulsants

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3
Q

What SSRIs/SNRIs are FDA approved for the treatment of generalized anxiety disorder(GAD)?

A

escitalopram, sertraline, paroxetine, venlafaxine, and duloxetine

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4
Q

What are the second line treatment options for generalized anxiety disorder?

A

-benzodiazepines (good efficacy but 2nd line due to SE and dependence)
-Imipramine (TCA)
-bupropion
-vilazodone and vortioxetine
-quetiapine ER
-buspirone
-hydroxyzine (good efficacy PRN)

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5
Q

What are the recommended follow up guidelines for generalized anxiety disorder?

A

-assess medication tolerability 1-2 weeks after initiation/change of therapy
-assess efficacy ~4 weeks after patient has been on a stable dosage of medication

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6
Q

What is the first line pharmacotherapy for panic disorder?

A

SSRI/SNRI

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7
Q

Which anxiety disorder is most likely to experience paradoxical increase in symptoms with initiation of SSRI/SNRIs?

A

Panic disorder

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8
Q

How can paradoxical increase in anxiety symptoms be managed with SSRIs?

A

Start with lower doses and titrate slowly or benzodiazepines PRN early on in therapy

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9
Q

Way is the best treatment for PTSD?

A

Psychotherapy

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10
Q

What is first line pharmacotherapy for PTSD?

A

SSRI/SNRIs

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11
Q

What PTSD symptoms can be relieved with SSRI/SNRIs?

A

Re-experiencing, avoidance, hyperarousal

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12
Q

What drugs may be used for sleep disturbances in PTSD?

A

-mirtazapine= sleep/nightmares
-prazosin (anti adrenergic agents)= sleep/nightmares
-trazodone= sleep/nightmares

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13
Q

What is the second line treatment for PTSD?

A

-anticonvulsants (not monotherapy)
-antipsychotics

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14
Q

In what anxiety disorders are benzodiazepines highly discouraged due to lack of evidence and even worsening of symptoms?

A

PTSD & OCD

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15
Q

What is the first line treatment for OCD?

A

SSRIs= fluoxamine

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16
Q

What is the dosing of SSRIs in OCD?

A

higher dosing than depression

17
Q

What are the second line treatment options for OCD?

A

-clomipramine (TCA)
-venlafaxine XR
-mirtazipine

18
Q

What are the third line treatment options in OCD?

A

antipsychotics or anticonvulsants

19
Q

How long to experience benefit with SSRI/SNRI treatment in anxiety?

A

2-4 weeks

20
Q

What antidepressant may worsen anxiety symptoms?

A

bupropion

21
Q

What is the dosing of Buspirone?

A

10-15mg BID-TID (max 60mg/day), best if scheduled and at least BID

22
Q

What are the common side effects of Buspirone?

A

dizziness, drowsiness, nausea

23
Q

What is the place in anxiety therapy for benzodiazepines?

A

panic disorder or severely distressing situations as “pill-in-pocket” approach- may be used in treatment refractory cases (scheduled with long-acting agents)

24
Q

What are the side effects of Benzodiazepines?

A

-sedation
-hypotension
-cognitive/motor impairments
-respiratory depression

25
Q

What are some pharmacokinetic parameters that are significant to benzodiazepines?

A

-faster time to peak effect= rapid symptom reduction but also increase euphoria in abuse)
-shorter t1/2= increased potential for withdrawal symptoms
-tolerance can develop

26
Q

What are the preferred benzodiazepines in hepatic dysfunction?

A

-lorazepam
-oxazepam
-temazepam

27
Q

What are the withdrawal symptoms of benzodiazepines?

A

-increased anxiety
-tremors
-tachycardia
-hallucinations
-seizures

28
Q

What are the risk factors for withdrawal of benzodiazepines?

A

long-term use (>4 weeks), high doses, short t1/2

29
Q

What benzodiazepine is preferred for tapering off strategies?

A

clonazepam

30
Q

What anticonvulsants may be used in anxiety disorders?

A

pregabalin or gabapentin

31
Q

Why may pregabalin be specifically useful in some patients?

A

improvement in sleep disturbance or somatic complaints (secondary physical symptoms of anxiety)

32
Q

What are the common side effects of pregabalin?

A

dizziness, drowsiness, headache

33
Q

What is the dosing regimen for hydroxyzine in anxiety disorders?

A

25-50mg PRN up to 4 times a day

34
Q

What are the side effects of hydroxyzine?

A

SEDATION
anticholinergic, blurred vision, confusion

35
Q

What antipsychotics are FDA approved for anxiety disorders?

A

none

36
Q

What is the use of beta-blocker (propranolol) in anxiety disorders?

A

performance anxiety, helpful for autonomic symptoms (tremors, tachycardia)

Therapeutics 3 (14 decks)

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