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Pharmacology > Anxiety > Flashcards

Anxiety Flashcards

1
Q

Anxiety

A

an uncomfortable feeling of vague fear or apprehension accomplished by characteristic physical sensations

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2
Q

Drug induced anxiety

A

caffeine, methylphenidate, cocaine, nicotine, albuterol, stimulants, methamphetamine, ephedrine, pseudoephedrine, levodopa, metoclopramide, ACh, SSRIs

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3
Q

Psychiatric conditions that induce anxiety

A

mood disorders, substance abuse, withdrawal, eating disorders, personality disorders

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4
Q

Medical conditions that induce anxiety

A

angina, arrhythmias, anemia, electrolyte imbalances, hypoglycemia, COPD, Asthma, hypo/hyperthyroidism

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5
Q

Drug withdrawal anxiety

A

barbiturates, benzo, narcs, EtOH, sedatives

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6
Q

Types of anxiety

A

situational, general, panic disorder, OCD, PTSD, social phobia

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7
Q

Generalized anxiety disorder

A

unrealistic or excessive anxiety about 2 or more life events for majority of days for more than 6 months, 2:3 m:f, onset late adolescence

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8
Q

Panic disorder

A

1-4% lifetime prevalence, women 2-3x more likely, onset late adolescence-30s, chronic but wax and wanes, recurrent and unexpected attacks, develop and peak withing 10 mins, 20-30 mins, agorophobia common

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9
Q

Obsessions

A

persistent ideas, thoughts, images or impulses that cause anxiety, pts attempt to ignore or suppress, pt often acknowledge the thoughts are product of mind; fear of germs, was an act performed

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10
Q

Compulsions

A

repetitive, intentional and purposeful behaviors in response to obsessions, sense of anxiety if not allowed to perform; washing hands, ordering, counting

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11
Q

PTSD

A

reaction of intense fear, helplessness, horror after exposure to traumatic event, persistent re-experience of the event, nightmares, flashbacks, avoidance of stimuli, acute 3 months, M:F 1:2, onset withing 3 months of event

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12
Q

Social phobia

A

fear of social or performance situations, exposure provokes anxiety, pt recognizes as unreasonable, onset teenage years, usually continuous

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13
Q

Locus coeruleus

A

brainstem nucleus containing 70% of noradrenergic neurons in the brain; implicated in GAD, panic, PTSD, OCD, social anxiety

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14
Q

stimulation of the LC results in

A

a fear response and sx of anxiety

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15
Q

GABA

A

inhibitory neurotransmitter for other neurotransmitters, GAD and panic

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16
Q

Benzos

A

agonist that binds to the BZD receptor and enhances GABA receptor binding, GAD and panic

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17
Q

Serotonin

A

neurons originate mostly in the raphe nucleus of brainstem and project into the cerebral cortex, limbic, and hypothalamus, GAD, panic, OCD, social anxiety

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18
Q

Non pharm approaches for anxiety

A

psychotherapy, relaxation, situational avoidance, exss

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19
Q

Pharm options

A

short term- BZDs, long term- buspirone, SSRIs, SNRIs, TCAs, resistant anxiety- BB, mood stabilizers

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20
Q

Benzos anxiety and panic

A

Alprazolam (Xanax), Lorazepam (ativan), Clonazepam (klonopin), Diazepam (Valium), chlordiazepoxide (Librium), Cloazepate (Tranxene), Flurazepam (Dalmane), Oxazepam (Serax), Midazolam (Versed)

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21
Q

Benzo sleep aids

A

temazepam (Restoril), Estazolam (Prosom), triazolam (Halcion)

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22
Q

Benzo MOA

A

binds to benzodiazepine receptors; enhances the inhibitory effects of GABA

23
Q

Prodrugs Benzo

A

diazepam, chlordiazepoxide, clorazepate- T1/2 of metabolite, more than 100 hrs w/ chronic use, very long acting, avoid in elderly

24
Q

Active parent drugs Benzo

A

lorazepam, oxazepam, alprazolam, clonazepam, no active metabolites, short T 1/2 (except clonazepam, long T1/2)

25
Q

Benzo lipophilicity

A

higher fat solubility improves passage into CNS, faster onset

26
Q

Disadvantages of Benzos

A

tolerance, dependence, addiction, need for taper, cog impairment, only symptomatic tx

27
Q

Dosage of alprazolam (Xanax)

A

.5-2 mg po.iv.im 6-8 hrs, max 10 mg daily

28
Q

dosage of Clonazepam (Klonopin)

A

.25-1 mg po BID-TID

29
Q

Dosage of Diazepam (valium)

A

2-10 mg po TID-QID, max 30 mg/8hrs

30
Q

Dosage lorazepam (ativan)

A

.5-2mg PO/IM/IV TID-QID, max 10 mg/day

31
Q

Benzodiazpines ADRs

A

CNS depression, resp depression, impaired memory, impaired cog, dysphagia, tolerance/ dependence

32
Q

BZD tolerance and dependence

A

does not usually occur to anxiolytic effect, may occur if higher daily doses for several weeks, smaller daily doses over several months, fast onset agent being utilized, avoid by using a slower onset drug, longer acting drug

33
Q

Drug interactions of BZD

A

other CNS depressants, drugs that compete with or inhibit metabolism, drugs that decrease absorption, grapefruit juice

34
Q

Discontinuation of therapy of BZD

A

must taper slowly, example 5-10% of dose every 2 weeks, may take months to successfully and safely taper to discontinue therapy

35
Q

Prevention of withdrawal of BZD

A

taper doses by switching to an agent w/ a shorter T1/2 or taper a certain percentage of daily dose/week until weaned off, taper over 4-12 weeks, monitor for relapse or rebound anxiety, monitor for withdrawal

36
Q

Withdrawal symptoms

A

irritability, muscle aches, nausea, hyperreflexia, could lead to seizures, coma or death if untreated

37
Q

Antidote for overdose of BZD

A

flumazenil (Romazecon), use is controversal, seizures

38
Q

Buspirone (BuSpar) MOA

A

mid brain modulator, has effects on norepinephrine, serotonin, dopamine, ACh, and GABA systems

39
Q

Clinical use of Buspirone (BuSpar)

A

GAD, social anxiety, OCD, PTSD (adjunct only)

40
Q

Buspirone (BiSpar) advantages

A

non-sedating, no interactions w/ CNS depressants, including EtOH, rare side effects, little or no effect on sexual function, no dependence

41
Q

Buspirone (BuSpar)

A

pts, often do not feel it is effective due to slow onset and lack of buzz, may take 2-6 weeks to get full effect, multiple daily dosing, chronic med

42
Q

SSRI dosing for anxiety

A

often higher than seen w/ depression, still start low and titrate

43
Q

Clinical use of SSRI

A

depression, OCD, panic, social anxiety, PTSD, more chronic

44
Q

Clomipramine (Anafranil)

A

TCA, used for OCD, not well tolerated (ACh side effects, 8-12 week for benefit), combo w/ SSRIs, benefit in chronic pain, avoid in heart disease, suicidal pts

45
Q

SNRI agents

A

Vanlafaxine, duloxetine

46
Q

SNRIs

A

avoid abrupt d/c, up to 4-6 weeks for benefit, titrate to full dose, benfit for chronic pain, initiate slowly

47
Q

SNRI uses

A

GAD, OCD, panic (if chronic), social anxiety

48
Q

Beta blockers used for

A

social anxiety (PRN), PTSD

49
Q

BB

A

reduces peripheral sx of anxiety, Propranolol (Inderal), non-selective BB, blunts norepi and epi, can cause drowsiness, fatigue, hypotension, N/V/D

50
Q

BB propranolol dosing

A

10 mg PO prior to event

51
Q

Mood stabilizers

A

augmenting agents following tx failure w/ 1st line agents, may reduce intrusive thoughts and sx of aggression, irritability, and hyperarousal in PTSD

52
Q

Mood stabilizing agents

A

Carbamazepine, divalproic acid, lamotrigine, gabapentin, topiramate, pregabalin, atypical antipsychotics

53
Q

Duration of tx of mood stabilizing agents

A

4-6 weeks, except BZD, anxiety disorders are often life-long, may require chronic tx, decision to D/C or taper must be individualized

Pharmacology (61 decks)

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