Anxiety

Question 1

What is needed to make diagnosis of anxiety disorder? (vs. just anxiety)

Answer 1

• some degree of dysfunction

* symptoms for at least 6 months

Question 2

Anticipatory anxiety?

Answer 2

worse before, better after event

Question 3

In specific phobias, does the person often recognize that the fear is exaggerated or unreasonable?

Answer 3

Yes

Question 4

Generalized Anxiety Disorder

Answer 4

Excessive worry and anxiety more days than not

3 or more of:
• Restless, keyed-up, on edge
• Easily fatigued
• Difficulty concentrating/ Mind goes blank
• Irritability
• Muscle tension
• Sleep disturbance

Question 5

What is Agoraphobia?

Answer 5

• Anxiety about being in situations from which
escape is difficult
• Avoidance of these situations or marked
distress/ anxiety about being in these situations
• Often occurs with panic attacks but not
necessarily

Question 6

Medications w/ anxiolytics target what 3 sets of neurotransmitters in:

• GAD?
• PTSD?
• Panic Disorders?
• OCD?

Answer 6

• GABA (GAD)
• Cortisol and Norepinephrine (PTSD)
• Serotonin (Panic, OCD, probably plays a role in all forms of anxiety)

Question 7

Adverse effect of using extinction as behavioral method?

Answer 7

Escalation of provoking behavior

Ex: child turns on sink for attention

• –> you ignore it
• –> child floods bathroom

Question 8

Benzodiazepines:
Target?
Advantage?
Problems?

Answer 8

Target = GABA

Advantage = effective in aborting anxiety

Problems =
• Not useful in prophylaxis
• Tolerance, addiction
• Toxicity in overdose esp with alcohol

Question 9

Clomipramine: Useful in _____

Answer 9

OCD & Social Anxiety Disorder

Question 10

SSRI/SNRI: Advantage? Disadvantage?

Answer 10

Advantage = non addictive, effective in broad range of disorders, lower toxiciy in overdose

Disadvantage = can take 4-12 weeks for effect

Question 11

Tx: Debilitating anticipatory/ performance anxiety

Answer 11

Beta-blockers

Question 12

Tx: Panic Disorder

Answer 12

SSRI

Benzo as adjunct

Question 13

Tx: PTSD

Answer 13

Treatment tends to be symptomatic

Question 14

Tx: Social Anxiety Disorder

Answer 14

SSRI

Clomipramine

Question 15

Tx: OCD

Answer 15

SSRI

Clomipramine

Question 16

Tx: Generalized Anxiety (GAD)

Answer 16

SSRI
SNRI
Buspirone

Question 17

Diagnosis?

3 or more of:
• Restless, keyed-up, on edge
• Easily fatigued
• Difficulty concentrating/ Mind goes blank
• Irritability
• Muscle tension
• Sleep disturbance

Answer 17

Generalized Anxiety Disorder

Question 18

Diagnosis?

• Anxiety about being in situations from which
escape is difficult
• Avoidance of these situations or marked
distress/ anxiety about being in these situations
• Often occurs with panic attacks but not
necessarily

Answer 18

Agoraphobia

Question 19

Anxiety does not typically require pharmacologic therapy, but under what conditions would it?

Answer 19

When anxiety significantly disrupts a person’s life, or is associated with symptoms such as panic, obsessions and/or compulsions, or disabling
phobias

Question 20

Antianxiety agents include..?

Answer 20

Benzodiazepines, Buspirone, SSRI’s, and SNRI’s

Question 21

Continued therapy with Diazepam decreases the __(a)__ effect as tolerance develops while the __(b)__ effect is preserved.

Answer 21

a) sedative

b) anxiolytic

Question 22

Diazepam decreases the amount of time spent in ____ sleep

Answer 22

stage 4

Question 23

In addition to its anxiolytic & sedative effects, Diazepam is an excellent _____

Answer 23

anticonvulsant

Question 24

______ is not water-soluble and the parenteral solution contains propylene glycol (the major ingredient in Sierra automobile antifreeze) as the vehicle

Answer 24

Diazepam

Question 25

T or F? | The withdrawal syndrome after abrupt discontinuation of diazepam may not begin for several days or a week or more.

Answer 25

True | due to its active metabolite, Nordazepam

Question 26

Adverse effects of Diazepam?

Answer 26

Sedation, Amnesia, Ataxia & Ventilatory Depression

Question 27

_____ is converted to diazepam.

Answer 27

Chlordiazepoxide

Question 28

_____is an active metabolite of diazepam that is converted to an inactive glucuronide and therefore has a shorter duration of action.

Answer 28

Oxazepam

Question 29

_____ has a longer duration of action than Diazepam.

Answer 29

Lorazepam

Question 30

_____ is particularly useful in panic disorder & agoraphobia.

Answer 30

Alprazolam

Question 31

_____ is used as an anticonvulsant but is also particularly useful in panic disorder.

Answer 31

Clonazepam

Question 32

_____ is an inverse agonist at the benzodiazepine receptor & is useful primarily in treating accidental or intentional overdoses.

Answer 32

Flumazenil | repeated dosing is often necessary b/c of its shorter duration of action

Question 33

2 benzodiazepines that are also indicated in panic disorder (in addition to GAD)?

Answer 33

Alprazolam & Clonazepam

Question 34

Is Buspirone effective in/for... - panic attacks? - anxiety? - sedation? - seizures? - does tolerance build up?

Answer 34

``` No Yes (anxiety) No No No ``` (note: it's a 5-HT1A partial agonist w/ little activity at dopamine or GABA receptors)

Question 35

Which is the only SSRI not used to treat depression?

Answer 35

Fluvoxamine

Question 36

Among the SSRI’s, _____ is unique in that it may cause congenital cardiac malformations when given during the first trimester.

Answer 36

Paroxetine

Question 37

Which 2 symptoms of Serotonin Syndrome are less common signs that are more likely to be associated with a fatal outcome?

Answer 37

Coma & Seizures

Question 38

SNRI's, similar to SSRI's are very safe, however one difference is that SNRI's may cause _____.

Answer 38

sedation

Question 39

_____ has a similar effect to the SNRI’s but does so via a unique mechanism of action

Answer 39

Mirtazapine

Question 40

Mirtazepine is a ___(a)___ and thus increases the release of both __(b)__ & __(c)__ from nerve terminals.

Answer 40

a) alpha-2 adrenoceptor antagonist b) norepinephrine c) serotonin

Question 41

____ & ____ are the only SSRI’s approved to treat an anxiety disorder (i.e., OCD) in children

Answer 41

Fluoxetine & Sertraline