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NAPLEX Content > Anxiety > Flashcards

Anxiety Flashcards

1
Q

List the common types of anxiety disorder?

A

Generalized anxiety disorder (GAD)

Panic disorder (PD)

Social anxiety disorder (SAD)

Obsessive compulsive disorder (OCD)

Post-traumatic stress trauma (PTSD)

Specific phobias

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2
Q

What class of drugs are primarily used to treat anxiety disorder?

A

SSRIs and SNRIs

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3
Q

Howz dosing initiated compared to depression?

A

Antidepressants for anxiety disorder is started at half the initial dose used for depression and is slowly titrated

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4
Q

Whys the initial dosing of antidepressant for anxiety half of that of depression?

A

To minimize stimulatory adverse effects, such as anxiousness and jitteriness

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5
Q

What’s the alternate way of initiating antidepressant in anxiety disorder?

A

Overlap antidepressant with benzodiazepine for 2-4 weeks to alleviate some of the initial stimulatory effects and regulate sleep

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6
Q

Why do some clinicians Overlap antidepressant with benzodiazepine for first 2-4 weeks?

A

To alleviate some of the initial stimulatory effects and regulate sleep

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7
Q

Should pt expect immediate relief when placed on SSRI?

A

No

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8
Q

When may noticeable improvement be seen?

A

After 4 or more weeks of tx

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9
Q

List the antidepressant agents with anxiety indication for SAD?

A

SFBPV

Sertraline

Fluvoxamine

Bupropion

Paroxetine

Venlafaxine

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10
Q

List the antidepressant agents with anxiety indication for OCD?

A

CFFPS

Citalopram

Fluoxetine

Fluvoxamine

Paroxetine

Sertraline

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11
Q

List the antidepressant agents with anxiety indication for PD?

A

PCFIVS

Paroxetine

Citalopram

Fluoxetine

Imipramine

Venlafaxine

Sertraline

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12
Q

List the antidepressant agents with anxiety indication for GAD?

A

PED V

Paroxetine

Escitalopram

Duloxetine

Venlafaxine

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13
Q

List the antidepressant agents with anxiety indication for PTSD?

A

Paroxentine

Sertraline

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14
Q

List the antidepressant agents with anxiety indication for anxiety?

A

Doxepin

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15
Q

What’s bupropion indicated for in anxiety disorder?

A

Social anxiety disorder (SAD)

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16
Q

What’s citalopram indicated for in anxiety disorder?

A

Obsessive compulsive disorder (OCD)

Panic disorder (PD)

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17
Q

What’s escitalopram indicated for in anxiety disorder?

A

Generalized anxiety disorder (GAD)

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18
Q

What’s fluoxetine indicated for in anxiety disorder?

A

Obsessive compulsive disorder (OCD)

Panic disorder (PD)

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19
Q

What’s fluvoxamine indicated for in anxiety disorder?

A

Obsessive compulsive disorder (OCD)

Social anxiety disorder (SAD)

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20
Q

What’s paroxetine indicated for in anxiety disorder?

A

GAD

OCD

SAD

PD

PTSD

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21
Q

What’s sertraline indicated for in anxiety disorder?

A

All except GAD (OCD, PD, PTSD, SAD)

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22
Q

What’s duloxetine indicated for in anxiety disorder?

A

GAD

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23
Q

What’s venlafaxine indicated for in anxiety disorder?

A

GAD

PD

SAD

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24
Q

What’s doxepin indicated for in anxiety disorder?

A

Anxiety

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25
Q

What’s imipramine indicated for in anxiety disorder?

A

PD

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26
Q

List common meds that can worsen anxiety

A 
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
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27
Q

What’s the brand name of hydroxyzine?

A

Vistaril

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28
Q

What’s hydroxyzine (Vistaril)?

A

FDA approved for anxiety… Occasionally used for short-term anxiety rather than prescribing BDZ (a potentially addicting med)

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29
Q

How does hydroxyzine (Vistaril) work?

A

Sedating antihistamine (not for long-term use)

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30
Q

What’s the brand name for pregabalin?

A

Lyrica

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31
Q

Uses of pregabalin (lyrica)?

A

Not FDA approved

Useful if pt also has neuropathic pain

32
Q

What meds is pregabalin (lyrica) similar to?

A

Immediate anxiolytic effects similar to lorazepam, alprazolam, and venlafaxine

33
Q

What’s the brand name of propranolol for anxiety disorder?

A

Inderal

34
Q

Uses of propranolol (inderal)?

A

Used to reduce sx of stage fright and performance anxiety

35
Q

Howz propranolol (inderal) dosed?

A

10-40mg 1hr prior to an event such as public speaking

36
Q

In what dx state is propranolol (inderal) contraindicated? Why?

A

Asthma, COPD

Inderal is non-selective beta-blocker

37
Q

Uses of busiprone in anxiety?

A

2nd line for pts who didn’t respond to antidepressant/ at risk for BDZ abuse/ or added as adjunctive agent

38
Q

What’s the brand name for Quetiapine?

A

Seroquel

39
Q

Uses of Quetiapine (Seroquel)?

A

Sometimes used for anxiety….not FDA approved for GAD

40
Q

Why should Quetiapine (Seroquel) be avoided?

A

Carries risks of Extrapyrimidal and neuroleptic malignant syndrome even at low doses and should be avoided

41
Q

List natural pdts used for anxiety

A

Valerian

Lemon balm

Glutamine

Passion flower and hops (both as tea)

Chamomile tea

Theanine

Skullcap

42
Q

Which pdt used for anxiety should be not recommended? Why not?

A

Kava

Can damage the liver

43
Q

Uses of BDZ?

A

For anxiety sx… They provide fast relief for acute sx, usually within a few days

44
Q

When is BDZ appropriate for use?

A

SHORT-TERM situations in which anxiety is acute

45
Q

Is BDZ always used short-term as recommended?

A

No. BDZ is often used chronically, even in the elderly

46
Q

Effect of BDZ use in the elderly?

A

Risks for confusion, dizziness, and falls

Risk increases with concurrent use of other CNS depressants

47
Q

According to BEERS criteria, is BDZ appropriate for elderly?

A

Beers deem BDZ potentially inappropriate for use in geriatric pts

48
Q

MOA of benzodiazepine?

A

Potentiate GABA, an inhibitory neurotransmitter, causing CNS depression

49
Q

List BDZ agents?

A

Lorazepam (Ativan)

Alprazolam (Xanax, Xanax XR)

Chlordiazepoxide (Librium)

Clonazepam (Klonopin)

Clorazepate (Tranxene, Gen-Xene)

Diazepam (Valium)

Oxazepam (Serax)

50
Q

What’s the brand name of lorazepam?

A

Ativan

51
Q

What’s the brand name of Alprazolam?

A

Xanax, Xanax XR

52
Q

What’s the brand name of clonazepam?

A

Klonopin

53
Q

What’s the brand name of diazepam?

A

Valium

54
Q

What class of controlled substance are the BZD?

A

C IV

Potential for abuse

55
Q

When does physiological dependence and tolerance develop with BZD use?

A

When BZD is used chronically

56
Q

SE of BZD?

A

Drowsiness

Dizziness

Weakness

Ataxia

Lightheadedness

57
Q

Which BZD are considered less potentially harmful for elderly or with liver impairment?

A

L-O-T

Lorazepam (Ativan)

Oxazepam (Serax)

Temazepam

58
Q

Why are the L-O-T BZD (Lorazepam, oxazepam, temazepam) less harmful in liver impairment and the elderly?

A

They are metabolized to inactive Compds (glucuronides)

59
Q

Pregnancy cat. of BZD? Possible effect on the fetus?

A

Cat. D

Risk of cleft lip/ palate

60
Q

If BZD is req during lactation, how is it used?

A

Short-acting agents such as Alprazolam (Xanax) or Lorazepam (Ativan) should be used

61
Q

List the short-acting BZD

A

Alprazolam (Xanax)

Lorazepam (Ativan)

62
Q

List meds that cause additive sedation with BZD?

A 
Most pain meds
Muscle relaxants
Antihistamines
Antipsychotics
Anticonvulsants
Mirtazapine (Remeron)
Trazodone
Alcohol
63
Q

List agents contraindicated with BZD use

A

Strong inhibitors such as grapefruit juice, Azoles antifungals

64
Q

List withdrawal sx of BZD

A 
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
65
Q

Is BZD generally recommended during pregnancy and breastfeeding?

A

No

66
Q

MOA of Buspirone

A

5-HT1 partial agonist:

67
Q

Advantage of busiprone over BZD?

A

Not controlled, no abuse or physiological potential

68
Q

How long does it take to get optimal effect with busiprone?

A

2-4 weeks for optimal effect

69
Q

SE of busiprone?

A

Nausea

Dizziness

Headache

70
Q

What med can’t be used with busiprone?

A

MAO inhibitors

Grapefruit juice

71
Q

List the meds that busiprone dose should be reduced with?

A

Erythromycin

Diltiazem

Itraconazole

Verapamil

Other 3A4 inhibitor

72
Q

List meds that may require an increase in Buspirone dose?

A

3A4 inducers including rifampin

73
Q

How does Buspirone come?

A

DIVIDOSE - scored into 3, so that dose can be adjusted accordingly

74
Q

How should Buspirone be taken? With or without food?

A

Either with if without food, but you must stick the the way you choose

75
Q

Effect of grapefruit on Buspirone?

A

Grapefruit may increase the amount of Buspirone in the bloodstream

76
Q

Should Buspirone be admin to nursing women?

A

No

77
Q

What’s the diff btw anxiety and anxiety disorder?

A

Anxiety disorders cause significant distress and interfere with the ability to lead a normal life.

Anxiety occurs occasionally

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