Anxiety Flashcards
List the common types of anxiety disorder?
Generalized anxiety disorder (GAD)
Panic disorder (PD)
Social anxiety disorder (SAD)
Obsessive compulsive disorder (OCD)
Post-traumatic stress trauma (PTSD)
Specific phobias
What class of drugs are primarily used to treat anxiety disorder?
SSRIs and SNRIs
Howz dosing initiated compared to depression?
Antidepressants for anxiety disorder is started at half the initial dose used for depression and is slowly titrated
Whys the initial dosing of antidepressant for anxiety half of that of depression?
To minimize stimulatory adverse effects, such as anxiousness and jitteriness
What’s the alternate way of initiating antidepressant in anxiety disorder?
Overlap antidepressant with benzodiazepine for 2-4 weeks to alleviate some of the initial stimulatory effects and regulate sleep
Why do some clinicians Overlap antidepressant with benzodiazepine for first 2-4 weeks?
To alleviate some of the initial stimulatory effects and regulate sleep
Should pt expect immediate relief when placed on SSRI?
No
When may noticeable improvement be seen?
After 4 or more weeks of tx
List the antidepressant agents with anxiety indication for SAD?
SFBPV
Sertraline
Fluvoxamine
Bupropion
Paroxetine
Venlafaxine
List the antidepressant agents with anxiety indication for OCD?
CFFPS
Citalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
List the antidepressant agents with anxiety indication for PD?
PCFIVS
Paroxetine
Citalopram
Fluoxetine
Imipramine
Venlafaxine
Sertraline
List the antidepressant agents with anxiety indication for GAD?
PED V
Paroxetine
Escitalopram
Duloxetine
Venlafaxine
List the antidepressant agents with anxiety indication for PTSD?
Paroxentine
Sertraline
List the antidepressant agents with anxiety indication for anxiety?
Doxepin
What’s bupropion indicated for in anxiety disorder?
Social anxiety disorder (SAD)
What’s citalopram indicated for in anxiety disorder?
Obsessive compulsive disorder (OCD)
Panic disorder (PD)
What’s escitalopram indicated for in anxiety disorder?
Generalized anxiety disorder (GAD)
What’s fluoxetine indicated for in anxiety disorder?
Obsessive compulsive disorder (OCD)
Panic disorder (PD)
What’s fluvoxamine indicated for in anxiety disorder?
Obsessive compulsive disorder (OCD)
Social anxiety disorder (SAD)
What’s paroxetine indicated for in anxiety disorder?
GAD
OCD
SAD
PD
PTSD
What’s sertraline indicated for in anxiety disorder?
All except GAD (OCD, PD, PTSD, SAD)
What’s duloxetine indicated for in anxiety disorder?
GAD
What’s venlafaxine indicated for in anxiety disorder?
GAD
PD
SAD
What’s doxepin indicated for in anxiety disorder?
Anxiety
What’s imipramine indicated for in anxiety disorder?
PD
List common meds that can worsen anxiety
Theophylline Levothyroxine Acetazolamide Albuterol (if used incorrectly - swallowed) Aripipazole, haloperidol Caffeine (in high doses) Stimulants Decongestants (Pseudoephedrine and nasally inhaled agents) Steroids Bupropion Fluoxetine, paroxetine Illicit drugs including cocaine, LSD, methamphetamine, others
What’s the brand name of hydroxyzine?
Vistaril
What’s hydroxyzine (Vistaril)?
FDA approved for anxiety… Occasionally used for short-term anxiety rather than prescribing BDZ (a potentially addicting med)
How does hydroxyzine (Vistaril) work?
Sedating antihistamine (not for long-term use)
What’s the brand name for pregabalin?
Lyrica
Uses of pregabalin (lyrica)?
Not FDA approved
Useful if pt also has neuropathic pain
What meds is pregabalin (lyrica) similar to?
Immediate anxiolytic effects similar to lorazepam, alprazolam, and venlafaxine
What’s the brand name of propranolol for anxiety disorder?
Inderal
Uses of propranolol (inderal)?
Used to reduce sx of stage fright and performance anxiety
Howz propranolol (inderal) dosed?
10-40mg 1hr prior to an event such as public speaking
In what dx state is propranolol (inderal) contraindicated? Why?
Asthma, COPD
Inderal is non-selective beta-blocker
Uses of busiprone in anxiety?
2nd line for pts who didn’t respond to antidepressant/ at risk for BDZ abuse/ or added as adjunctive agent
What’s the brand name for Quetiapine?
Seroquel
Uses of Quetiapine (Seroquel)?
Sometimes used for anxiety….not FDA approved for GAD
Why should Quetiapine (Seroquel) be avoided?
Carries risks of Extrapyrimidal and neuroleptic malignant syndrome even at low doses and should be avoided
List natural pdts used for anxiety
Valerian
Lemon balm
Glutamine
Passion flower and hops (both as tea)
Chamomile tea
Theanine
Skullcap
Which pdt used for anxiety should be not recommended? Why not?
Kava
Can damage the liver
Uses of BDZ?
For anxiety sx… They provide fast relief for acute sx, usually within a few days
When is BDZ appropriate for use?
SHORT-TERM situations in which anxiety is acute
Is BDZ always used short-term as recommended?
No. BDZ is often used chronically, even in the elderly
Effect of BDZ use in the elderly?
Risks for confusion, dizziness, and falls
Risk increases with concurrent use of other CNS depressants
According to BEERS criteria, is BDZ appropriate for elderly?
Beers deem BDZ potentially inappropriate for use in geriatric pts
MOA of benzodiazepine?
Potentiate GABA, an inhibitory neurotransmitter, causing CNS depression
List BDZ agents?
Lorazepam (Ativan)
Alprazolam (Xanax, Xanax XR)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Clorazepate (Tranxene, Gen-Xene)
Diazepam (Valium)
Oxazepam (Serax)
What’s the brand name of lorazepam?
Ativan
What’s the brand name of Alprazolam?
Xanax, Xanax XR
What’s the brand name of clonazepam?
Klonopin
What’s the brand name of diazepam?
Valium
What class of controlled substance are the BZD?
C IV
Potential for abuse
When does physiological dependence and tolerance develop with BZD use?
When BZD is used chronically
SE of BZD?
Drowsiness
Dizziness
Weakness
Ataxia
Lightheadedness
Which BZD are considered less potentially harmful for elderly or with liver impairment?
L-O-T
Lorazepam (Ativan)
Oxazepam (Serax)
Temazepam
Why are the L-O-T BZD (Lorazepam, oxazepam, temazepam) less harmful in liver impairment and the elderly?
They are metabolized to inactive Compds (glucuronides)
Pregnancy cat. of BZD? Possible effect on the fetus?
Cat. D
Risk of cleft lip/ palate
If BZD is req during lactation, how is it used?
Short-acting agents such as Alprazolam (Xanax) or Lorazepam (Ativan) should be used
List the short-acting BZD
Alprazolam (Xanax)
Lorazepam (Ativan)
List meds that cause additive sedation with BZD?
Most pain meds Muscle relaxants Antihistamines Antipsychotics Anticonvulsants Mirtazapine (Remeron) Trazodone Alcohol
List agents contraindicated with BZD use
Strong inhibitors such as grapefruit juice, Azoles antifungals
List withdrawal sx of BZD
Seizures Trouble sleeping Mental/ mood changes Increased rxns to noise/touch/light Nausea, vomiting, diarrhea Loss of appetite Stomach pain Hallucination Numbness/tingling of arms and legs Muscle pain Fats heartbeat Short-term memory loss Very high fever
Is BZD generally recommended during pregnancy and breastfeeding?
No
MOA of Buspirone
5-HT1 partial agonist:
Advantage of busiprone over BZD?
Not controlled, no abuse or physiological potential
How long does it take to get optimal effect with busiprone?
2-4 weeks for optimal effect
SE of busiprone?
Nausea
Dizziness
Headache
What med can’t be used with busiprone?
MAO inhibitors
Grapefruit juice
List the meds that busiprone dose should be reduced with?
Erythromycin
Diltiazem
Itraconazole
Verapamil
Other 3A4 inhibitor
List meds that may require an increase in Buspirone dose?
3A4 inducers including rifampin
How does Buspirone come?
DIVIDOSE - scored into 3, so that dose can be adjusted accordingly
How should Buspirone be taken? With or without food?
Either with if without food, but you must stick the the way you choose
Effect of grapefruit on Buspirone?
Grapefruit may increase the amount of Buspirone in the bloodstream
Should Buspirone be admin to nursing women?
No
What’s the diff btw anxiety and anxiety disorder?
Anxiety disorders cause significant distress and interfere with the ability to lead a normal life.
Anxiety occurs occasionally
