Anxiety

Question 1

generalized anxiety disorder DOC

Answer 1

anti-depressants - venlafaxine and SSRIs (preferred over TCAs)

note* onset of effects take 2-4 weeks

Question 2

when to use benzodiazepines in GAD pt

Answer 2

acute tx - work w/in minutes

OR

adjunct during initiation of anti-depressant therapy

OR

improve sleep

Question 3

benzodiazepines AE

Answer 3

physiologic and psychologic dependence

good to start pt with benzo + SSRI - but slowly taper off benzos and continue SSRI

Question 4

buspirone

Answer 4

partial agonist at 5HTA receptor

used in GAD
gradual onset of action - 2 weeks

no abuse potential, no withdrawal rxn

2nd line d/t inconsistency

Question 5

alternative GAD drugs

Answer 5

hydroxyzine

pregabalin

Question 6

panic disorder tx

Answer 6

SSRI DOC
(use TCA or MAOI when SSRI not effective)

may use benzo’s acutely or for initiation

Question 7

benzodiazepine of choice for panic disorder

Answer 7

alprazolam

AE: rebound anxiety, withdrawal syndrome, seizures

Question 8

social anxiety disorder DOC

Answer 8

SSRI

onset of response - 8 to 12 weeks

Question 9

OCD DOC

Answer 9

1) clomipramine
2) fluoxetine
3) fluvoxamine
4) paroxetine
5) sertraline

SSRI’s prefered

highly anxiosu - give benzo

Question 10

PTSD DOC

Answer 10

SSRIs

Question 11

acute tx of PTSD

Answer 11

setraline and paroxetine both approved

sertraline also approved for long term management of PTSD

Question 12

performance anxiety DOC

Answer 12

b blockers with high lipophilicity = propranolol nadolol