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Therapeutics (Fall 2024) > Anxiety > Flashcards

Anxiety Flashcards

1
Q

What are the compulsions of OCD?

A
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2
Q

What are the treatment principels for SAD?

A
  • 1st line treatment includes individual CBT
    specifically designed for SAD or SSRIs
  • If CBT and pharmacotherapy declined: interpersonal
    therapy
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3
Q

What is Buspirone?

A

buspirone is a 5-HT1A agonist effective only in GAD and to
potentiate antidepressants

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4
Q

What is the third line therapy for PD?

A

Phenelzine

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5
Q

What is the 2nd line pharmacotherapy for panic disorder?

A
  • TCAs: similar efficacy to SSRI/SNRIs but less well tolerated
  • Augment with SGA or BZD: depending on comorbidity
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6
Q

What are the main SNRIs?

A

Dulocetine
Venalafaxine
Desvenlafaxine
(main ones)

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7
Q

What is the targeted bedtime dose for prazosin?

A
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8
Q

What is the benefit of long acting Benzos?

A

Long Acting= good choice for tapering as less risk of withdrawal (i.e. diazepam, clonazepam), more
daytime sedation

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9
Q

What is the Ham-A

A
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10
Q

What are Benzos generally reserved for?

A
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11
Q

What are the LOT drugs?

A

LOT drugs (lorazepam, oxazepam, temazepam)
preferred in elderly and liver dysfunction due to no
active metabolites

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12
Q

What are the treatment principles of anxiety?

A
  • Psychotherapy + pharmacotherapy
  • Psychotherapy is least invasive and safest
  • Pharm indicated if sxs severe enough to produce fxnal disability
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13
Q

What is the risk of using flumazenil?

A

Reverses hypnotic-sedative
effect of BZD but clinically use is
limited due to risk of causing
seizures in BZD dependant
patients

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14
Q

Which 2 Benzo have the longest half life?

A

Not lorazepam

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15
Q

What are the obsessions of OCD?

A
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16
Q

What is the timeframe for OCD treatment?

A
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17
Q

What is exeprienced with PTSD?

A
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18
Q

What is the role of gaba?

A

principal inhibitory NT in brain that plays a role in
↓ activity of neurons (amygdala, CSTC)

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19
Q

What is the antidone for benzos?

A

Flumazenil

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20
Q

What are the goals of therapy for GAD? Long

A

Also treat comborbid conditions

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21
Q

What are the signs and symptoms of SAD?

A
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22
Q

What are the AE of Benzos?

A
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23
Q

What is the pathophysiology of anxiety>

A

2 parts: fear and worry sections

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24
Q

What are the precautions of opioid use?

A

Subsequent substance use may cause profud respiratory depression, coma and death

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25
Q

What are the goals of pharmacotherapy in PTSD?

A

Symptom reduction
Improve
Minimize

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26
Q

How is fear/worry treated?

A

NE reuptake inhibitors

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27
Q

What is the role of Benzos in GAD?

A

W

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28
Q

What are the psychological and cognitive symptoms of GAD?

A
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29
Q

What are the non-pharm treatments of OCD?

A

CBT, DBS, radio frequency wave surgery (reserved for refatory)

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30
Q

What are the goals of therapy for GAD? Acute

A
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31
Q

What are the comborbidities of GAD?

A

90% of GAD present with comorbid mental disorders during their life.

Can occur with other physicla health problems and may exacerbate them

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32
Q

What are the second line therapies for OCD that we should remember?

A

Clomipramine

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33
Q

What are the increased rates of medical comorbidites?

A

CVD, respiratory disorders, autoimmune disorders

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34
Q

What are the physical symptoms of a panic attack?

A
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35
Q

What are the psychological symptoms of a panic attack?

A
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36
Q

Anxiety disorders include disorders that share features

A

excessive fear and anxiety & related behavioral disturbances

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37
Q

What is the difficulties with GAD pharmacotherapy?

A

Current data does not provide
guidance as to whether it is best to
increase to dose, augment, or switch
when there has been a partial
response to drug therapy

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38
Q

What are the anxiety disorders focused on?

A
39
Q

What is the duration/timeline of PD treatment timeframes?

A
40
Q

What are the non-pharm treatments of GAD?

A

Reduce/avoid alcohol
Avoide non-prescription stimulants and medications known to induce anxiety
Exercise
Therapy
Relaxtion
Biofeedabck

41
Q

What is the benefit for short acting benzos?

A

Nothing… Short Acting= better hypnotic and sedative properties but more rebound anxiety (i.e.
lorazepam), inter-dose withdrawal, anterograde
amnesia

42
Q

Who usually encounters OCD first?

A
43
Q

What is PTSD?

A
44
Q
A
45
Q

What is GABA?

A

key NT for anxiety and the role of anxiolytics

46
Q

What is the Cortico-straito thalmo corticol circuitry?

A

Controls 2nd core symptom of worry

47
Q

What are voltage sensitive calcium channels? and A2D ligands?

A
48
Q

What are the screening tools used for PTSD?

A

Clinician Administered PTSD Scale for DSM-5 (CAPS-5)
* Weekly, monthly, lifetime versions
PTSD Check List-5 (PCL-5)
* Self-report

49
Q

What is the pathophys of OCD?

A
50
Q

What are the non-pharm treatments of PD?

A

CBT

51
Q

What is the monitoring of OCD?

A

Monitor weekly x 4 weeks then biweekly. Once stable monitor Q1-2 months

52
Q

What is the role of serotonin in anxiety?

A
  • 5-HT is a key NT innervating the amygdala and CSTC
  • Assists with regulating fear and worry
53
Q

What neutransmitters regulate the amygdala centered circuit?

A
54
Q

What is the assessment tool used for OCD?

A

Y-BOCS

55
Q

How do Gaba/Pregab affect VSVV?

A

gabapentin & pregabalin bind to the α2δ subunit of the
presynaptic N and P/Q VSCC to block release of glutamate
when neurotransmission is excessive (amygdala and CSTC
loop) to decrease fear and worry

56
Q

What is the Amygdala?

A

Affects resposne of fear (Fight/flight)

57
Q

What is not rcommended for PTSD Treatment?

A

Alprazolam
Clonazepam

58
Q

What are the rating scales for PD?

A
59
Q

What are the non-pharm treatments of PTSD?

A
60
Q

What are the comorbidities of anxiety disorders?

A
61
Q

What are the impornant GAD treatment timeframes for SSRis/SNRIs?

A
62
Q

What is considered second line treatment for SAD?

A

Venlafaxine or alternative SSRI maybe pregabalin

63
Q

Typical timeframe for SAD?

A
64
Q

What is the efficacy of benoz in GAD?

A

Provides rapid initial relief of anxiety symptoms, but effects may not be significantly
different from placebo after 4-6 weeks of treatment

65
Q

What is the role of NE in anxiety?

A

NE is regulator to amygdala and to PFC/thalamus in CSTC circuits by attaching to α1 & β1 adrenergic receptor

66
Q

What is the Psychopharmacology Algorithm
Project at the Harvard South Shore
Program?

A

Helps provide guidance on next steps of GAD treatment

67
Q

What is a panic disroder?

A

Recurrent unexpected panic attacks with at
least 1 of the attacks being followed by a month
or longer of at least 1 of the following:

68
Q

What are he mian risk factors of PTSD?

A

Trauma, lack of social support, life stress

69
Q

What are the 2nd line therapies for anxiety?

A

BZD (short-term use):
alprazolam, lorazepam,
diazepam
Bupropion
Buspirone
Hydroxyzine

70
Q

How is hyperarousal such as nightmares managed?

A

A1 blockers such as prazosin

71
Q

WHat are atenolol and propranolol used for?

A

May help with decreasing heart reate to help perform better. A good medication to help decrease HR

72
Q

What is the timeframe for PTSD?

A
73
Q

what are the three dimensions of ptsd?

A
74
Q

What are the rating scales for SAD?

A
75
Q

What are drugs that may be associated with increased anxiety symptoms?

A
76
Q

WHo does SAD affect more

A

Elderly and females

77
Q

What is an issue with Benzos?

A

Dependence:
* Psychological and physical dependence may develop with long-term use

  • Risk of dependence increases with higher dose and/or longer use
  • Risk further increased with history of alcohol use disorder or other substance use disorders or personality disorders
  • Withdrawal symptoms can occur following discontinuation
78
Q

What neurotransmitters can regulate the CSTC of the brain?

A
79
Q

What are the treatment approaches of OCD?

A
  • Guidelines recommend CBT or pharmacotherapy with
    SSRI as 1st line
  • Combo treatment can be considered
  • Trial 1st line pharmacotherapy for min 12 wks and CBT trial of
    13 weekly sessions before concluding inadequate response.
  • Symptom reduction often takes 6-8 wks (up to 10-12 weeks)
80
Q

What are the 1st line drugs recommened for PTSD?

A

SSRI
SNRI
Prazosin (Trauma related nightmares and to improve sleep)

81
Q

What are the first line treatments for Anxiety in Canada?

A

SSRI: escitalopram,
paroxetine, sertraline
SNRI: duloxetine,
venlafaxine,
Pregabalin

82
Q

What is the estimated relapse time of OCD?

A

24-89%

83
Q

What are the firstl ine option SSRIs for PD?

A
84
Q

What are the physical symptoms of GAD?

A

W

85
Q

What is a panick attack?

A

A distinct period of intense fear or discomfort when 4 or more symptoms develop suddenly and achieve a peakwithin 10 minutes:

86
Q

hat are the impariment of GAD?

A
87
Q

What is the GAD-7?

A
88
Q

Screen shot of the Benzos next slide

A
89
Q

What is the DSM-5 criteria of anxiety?

A

excessive anxiety and worry occuring more days than not for at least 6 months about a number of events or activities

unable to control the worry

Restlessness or feeling keyed up or on edge
Being fatiqued
Concnetrating
Irritable
Muscle tension
Sleep disturbances

90
Q

What are the first line options of OCD treatment?

A

SRI: escitalopram, fluoxetine,
fluvoxamine, paroxetine, sertraline
SNRI: venlafaxine
Adj: aripiprazole, risperidone

91
Q

What iare the signs of Benzo withdrawal?

A
  • Withdrawal Symptoms: sweating, tremor, nausea, vomiting,rebound anxiety, ↑ heart rate, insomnia, agitation,twitching, visual/tactile hallucinations, SEIZURES (onsetwithin 1-2 days after BZD stopped)
92
Q

What are the 1st line pharmacotherapy for treatment of PD?

A

SSRIs or venlafaxine

BZDs are reserved for acute or residual anxiety

93
Q

What is the Mental statys exam?

A

Therapeutics (Fall 2024) (11 decks)

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