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662 > Anxiety > Flashcards

Anxiety Flashcards

1
Q

What are the risk factors for anxiety?

A
  • Women - Age: develops prior ro age 30 - Family history of anxiety or depression - Life stressors
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2
Q

Pathophysiology of Anxiety?

A
  • Abnormal NT functioning in the amygdala, GABA, NE, Serotonin - Corticotrophin releasing factor - Cholecystokinin - Glutamate - Substance P
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3
Q

Classifications of anxiety

A
  • Generalized anxiety disorder - Panic disorder - Social anxiety disorder - Obsessive-compulsive disorder - Post traumatic stress disorder - Specific phobias
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4
Q

Nonpharm treatment of Anxiety?

A
  • Psychotherapy - Cognitive behavioral therapy - Meditation - Exercise - Avoid caffeine, stimulants, diet pills, or other meds that cause anxiety - Identify and remove causes of anxiety
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5
Q

Pharmacologic treatment of anxiety

A
  • Antidepressants SSRI, ANRIs, TCAs - Benxodiazepines - Buspirone - Hydroxyzine - Pregabalin
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6
Q

GAD 1st and 2nd line?

A

1st: SSRIs/SNRIs 2nd: Benzos as needed, buspirone

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7
Q

Panic disorder first line?

A

SSRIs may need scheduled benzos for 2-4 weeks May need PRN benzo for attacks

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8
Q

OCD? 1st line and 2nd line?

A

1st: SSRIs (high dose) or CBT or both 2nd line: Clomipramine or antipsychotic augmentation

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9
Q

Social anxiety 1st and 2nd line

A

1st SSRI/ SNRIs 2nd: Benzos Beta blockers for performance anxiety

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10
Q

PTSD 1st line? Adjunctive agents? What not to give?

A

1st SSRIs, SNRIs, Add Prazosin or antipsychotic or mood stabalizer No benzos

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11
Q

Specific phobia treatment?

A

CBT

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12
Q

SSRIs first line for GAD, PD, OCD, Social anxiety, PTSD

A
  • Start at a lower dose - Can initially cause anxiety - Slower onset than benzos - Need higher dosages for OCD
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13
Q

You need a higher when starting an SSRI with what disease?

A

OCD

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14
Q

Escitalopram is approved for the treatment of?

A

Approved for GAD

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15
Q

Fluoxetine is approved for?

A

approved for PD

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16
Q

Fluvoxamine approved for the treatment of?

A

OCD

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17
Q

Paroxetine approved for the treatment of?

A

treatment of GAD, OCD, PD, PTSD, SAD

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18
Q

Sertraline Approved for the treatment of?

A

treatment of OCD, PTSD

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19
Q

Venlafaxine XR approved for the treatment of?

A

GAD and SAD

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20
Q

Duloxetine treatment of?

A

GAD

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21
Q

What are the SEs of SSRIs?

A

S-Stomach (N/V/D) S- Sexual dysfunction R- Restlessness, Jitteriness I- Insomnia Headache, Weight gain, withdrawal from abrupt discontinuation

22
Q

Antidepressant tips - If one SSRI/SNRI is ineffective what should be done? - Patients often become tolerant to what? - These medications require? - How many weeks does it take to see response? - When you stop an SSRI how do you do it?

A
  • You should try another one - SEs usually stop within a few weeks expect for Sexual Dysfunction - These require daily administration - Often take 4 weeks or more to see effect - Upon discontinuation you have to taper
23
Q

Benzo are ___ line or adjunct for? Most effective for? Shouldnt be used to treat?

A

2nd line for anxiety Most effective for acute symptoms Not effective for OCD or PTSD

24
Q

What benzos have a very fast onset?

A

Alprazolam, Diazepam (super fast)

25
Q

LOT what are the drugs and what are they good for?

A

Temazepam, Lorazepam, Oxazepam Good for the liver Little to no CYP metabolism

26
Q

Benzos with slow onset?

A

Oxazepam, Clonazepam, Lorazepam

27
Q

Im administration what benzo?

A

Lorazepam

28
Q

Most benzos are substrates for?

A

CYP3A4

29
Q

Substrate of 2C19

A

Diazepam

30
Q

Inhibitors of CYP3A4

A

Amiodarone, Azoles, AIDS protease inhibitors, Cimetidine, Ciprofloxacin, Clarithromycin/Erythromycin, CCBs (Diltiazem/Verapamil) Fluvoxamine, Grapefruit, Nefazodone

31
Q

SEs of benzos?

A

Sedation, Psychomotor, Impairment, Ataxia, Anterograde amnesia, Confusion, disorientation, Excitement/aggression, Addiction,

32
Q

You can die from benzos if you take what?

A

Drink on them or take CNS depressants

33
Q

Very new black box warnign for Benzos, opiod analgesics?

A

Serious risks associated with combined use of opioid medications and benzos Risk include extreme sleepiness, respiratory depression, coma and death

34
Q

Less serious withdrawal symptoms of benzos?

A
  • Anxiety
  • Irritability
  • Tremor
  • Insomnia
  • Muscle weakness
  • Nausea
    *
35
Q

Serious withdrawal symptoms of benzos?

A
  • Confusion
  • Delirium
  • Psychosis
  • Seizures
36
Q

What types of benzos have an increased risk of addiction?

A
  • Short half life
  • Long duration of use
37
Q

More severe withdrawal symptoms after ____ months but when can dependence start?

A

3 months

Dependence can occur 3-6 weeks of treatment

38
Q

Slow tapering is necessary for what type of benzos?

A

Short half life due to withdrawal symptoms

39
Q

Guide to tapering Benzos

A
40
Q

What are the 2 tapering methods for benzos?

A
  • Method 1
    • 25% decrease every few days (5-7) until 50% of original dose reached
    • Then 1/8 dose reduction every 4-7 days
    • Alprazolam cannot be tapered more than 0.5 mg Q3D
  • Method 2
    • Subsitute a long half life agent (Diazepam, Clonazepam) using equivalent dosages
    • Long acting benzos are easier to taper than short acting
41
Q

Guidelines for pregnancy and lactation with benzos

What should you use instead?

A
  • Benzos should be avoided
  • Cleft palate especially in the first trimester
  • Lethargy and poor temperature regualtion (floppy baby) in nursing mothers
  • SSRI if you need a PRN use Diphenhydramine, or Hydroxazine
42
Q

Tips for benzos

A
  • Weigh out the benefit vs. the risk
    • Risk of dependence, avoid in patients with history of substane abuse
43
Q
  • Benzos are especially useful during ___ treatment
  • Overall durations of benzos should not exceed?
  • Benzos with what are generally preferred over ____ with the treatmetn of GAD
  • Higher doses are generally required for what disorder?
A
  • initial treatment
  • 4-6 months
  • longer half life better
  • Panic disorder
44
Q

Buspirone indication?

max dose?

SEs?

Good alternative for?

What is the onset?

A
  • GAD
  • 60 mg/day
  • Dizziness, Nausea, Headache, Dysphoria
  • Alternative to benzos for patients with substance abuse history
  • onset is slow 4-6 weeks
45
Q

WHat other medications can be used for the treatment of anxiety?

A
  • Antihistamines, Hydroxazine (FDA approved), Diphenhydramine
  • Anticonvulsants
    • Pregabalin
    • Gabapentin
  • Antipsychotics
    • Quintiapine
  • Beta blockers
    • Propranolol (public speeching)
  • TCAs
    • Chlorimipramine (OCD)
46
Q

When can you attempt to stop anxiety meds?

GAD

PD and OCD

social anxiety

Resume if?

Lifelong treatmetn for?

A
  • 12 months GAD
  • 12-24 months in PD and OCD
  • 1 year for social anxiety
  • Life long if 2-4 relapses
47
Q

PTSD

The event is persistnetly reexperienced

What to avoid

Symptoms for longer than?

A

Avoid stimulants

Symptoms longer than 1 month

48
Q

Non pharm treatment for PTSD?

A
  • Short term: Stress management, hypnosis
  • CBT
  • Eyemovement desensitization and reprocessing
49
Q

First line treatment for PTSD?

Second line?

A

SSRIs or venlafaxine

Mirtazepine, or TCA, Adjunctive medications

BENZOS are not effective

50
Q

Adjunctive therapy for PTSD?

A
  • Prazosin
    • Stops nightmares
  • Atypical antipsychotics
    • Reserved for non-responders
    • Intrusive thoughts and hypervigilance
  • Anticonvulsants
    • Anger and aggression
    • Limited data, lamotrigine has some data

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