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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
What's imipramine indicated for in anxiety disorder?
PD
26
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 ```
27
What's the brand name of hydroxyzine?
Vistaril
28
What's hydroxyzine (Vistaril)?
FDA approved for anxiety... Occasionally used for short-term anxiety rather than prescribing BDZ (a potentially addicting med)
29
How does hydroxyzine (Vistaril) work?
Sedating antihistamine (not for long-term use)
30
What's the brand name for pregabalin?
Lyrica
31
Uses of pregabalin (lyrica)?
Not FDA approved Useful if pt also has neuropathic pain
32
What meds is pregabalin (lyrica) similar to?
Immediate anxiolytic effects similar to lorazepam, alprazolam, and venlafaxine
33
What's the brand name of propranolol for anxiety disorder?
Inderal
34
Uses of propranolol (inderal)?
Used to reduce sx of stage fright and performance anxiety
35
Howz propranolol (inderal) dosed?
10-40mg 1hr prior to an event such as public speaking
36
In what dx state is propranolol (inderal) contraindicated? Why?
Asthma, COPD Inderal is non-selective beta-blocker
37
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
38
What's the brand name for Quetiapine?
Seroquel
39
Uses of Quetiapine (Seroquel)?
Sometimes used for anxiety....not FDA approved for GAD
40
Why should Quetiapine (Seroquel) be avoided?
Carries risks of Extrapyrimidal and neuroleptic malignant syndrome even at low doses and should be avoided
41
List natural pdts used for anxiety
Valerian Lemon balm Glutamine Passion flower and hops (both as tea) Chamomile tea Theanine Skullcap
42
Which pdt used for anxiety should be not recommended? Why not?
Kava Can damage the liver
43
Uses of BDZ?
For anxiety sx... They provide fast relief for acute sx, usually within a few days
44
When is BDZ appropriate for use?
SHORT-TERM situations in which anxiety is acute
45
Is BDZ always used short-term as recommended?
No. BDZ is often used chronically, even in the elderly
46
Effect of BDZ use in the elderly?
Risks for confusion, dizziness, and falls Risk increases with concurrent use of other CNS depressants
47
According to BEERS criteria, is BDZ appropriate for elderly?
Beers deem BDZ potentially inappropriate for use in geriatric pts
48
MOA of benzodiazepine?
Potentiate GABA, an inhibitory neurotransmitter, causing CNS depression
49
List BDZ agents?
Lorazepam (Ativan) Alprazolam (Xanax, Xanax XR) Chlordiazepoxide (Librium) Clonazepam (Klonopin) Clorazepate (Tranxene, Gen-Xene) Diazepam (Valium) Oxazepam (Serax)
50
What's the brand name of lorazepam?
Ativan
51
What's the brand name of Alprazolam?
Xanax, Xanax XR
52
What's the brand name of clonazepam?
Klonopin
53
What's the brand name of diazepam?
Valium
54
What class of controlled substance are the BZD?
C IV Potential for abuse
55
When does physiological dependence and tolerance develop with BZD use?
When BZD is used chronically
56
SE of BZD?
Drowsiness Dizziness Weakness Ataxia Lightheadedness
57
Which BZD are considered less potentially harmful for elderly or with liver impairment?
L-O-T Lorazepam (Ativan) Oxazepam (Serax) Temazepam
58
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)
59
Pregnancy cat. of BZD? Possible effect on the fetus?
Cat. D Risk of cleft lip/ palate
60
If BZD is req during lactation, how is it used?
Short-acting agents such as Alprazolam (Xanax) or Lorazepam (Ativan) should be used
61
List the short-acting BZD
Alprazolam (Xanax) Lorazepam (Ativan)
62
List meds that cause additive sedation with BZD?
``` Most pain meds Muscle relaxants Antihistamines Antipsychotics Anticonvulsants Mirtazapine (Remeron) Trazodone Alcohol ```
63
List agents contraindicated with BZD use
Strong inhibitors such as grapefruit juice, Azoles antifungals
64
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 ```
65
Is BZD generally recommended during pregnancy and breastfeeding?
No
66
MOA of Buspirone
5-HT1 partial agonist:
67
Advantage of busiprone over BZD?
Not controlled, no abuse or physiological potential
68
How long does it take to get optimal effect with busiprone?
2-4 weeks for optimal effect
69
SE of busiprone?
Nausea Dizziness Headache
70
What med can't be used with busiprone?
MAO inhibitors Grapefruit juice
71
List the meds that busiprone dose should be reduced with?
Erythromycin Diltiazem Itraconazole Verapamil Other 3A4 inhibitor
72
List meds that may require an increase in Buspirone dose?
3A4 inducers including rifampin
73
How does Buspirone come?
DIVIDOSE - scored into 3, so that dose can be adjusted accordingly
74
How should Buspirone be taken? With or without food?
Either with if without food, but you must stick the the way you choose
75
Effect of grapefruit on Buspirone?
Grapefruit may increase the amount of Buspirone in the bloodstream
76
Should Buspirone be admin to nursing women?
No
77
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

psych 1166 (20 decks)

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