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Anxiety Flashcards

1
Q

First Line Treatment for Generalized Anxiety Dx….

A

SSRI OR SNRI

Duloxetine
Escitalopram
Paroxetine
Sertraline
Vanlafaxine
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2
Q

Duloxetine

A

Cymbalta
SNRI
30mg

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3
Q

Escitalopram

A

Lexapro
SSRI
10 mg

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4
Q

Paroxetine

A

Paxil
SSRI
20 mg

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5
Q

Sertraline

A

Zoloft
SSRI
1st line agent but doesnt say “FDA approved”
50mg

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6
Q

Venlafaxine XR

A

Effexor
SSRI
37.5 mg

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7
Q

How long to trial a drug before assessing for response…

A

4-6 weeks

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8
Q

BENZOS FOR ANXIETY DX…

A 
Alprazolam (XANAX)
Chlordiazepoxide (LIBRIUM)
Clonazepam (KLONOPIN)
Clorazepate (TRANXENE)
Diazepam (VALIUM)
Lorazepam (ATIVAN)
Oxazepam (SERAX)
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9
Q

Alprazolam

A

XANAX

Anx, Anx w/depression, Panic Disorder

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10
Q

Chlordiazepoxide

A

LIBRIUM

Anx, Pre-op anx, Alcohol withdraw

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11
Q

Clonazepam

A

KLONOPIN

Anticonvulsant, Panic dx

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12
Q

Clorazepate

A

TRANXENE
Anx, Alcohol withdraw, Anticonvulsant
PRODRUG

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13
Q

Diazepam

A

VALIUM

Anx, muscle rlx, Alcohol withdraw, preop anx, anticonvulsant

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14
Q

Lorazepam

A

ATIVAN

Anx, Anx/depression, anticonvulsant, premed anesthetic

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15
Q

Oxazepam

A

SERAX

Anx, alcohol withdraw

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16
Q

Metabolism through Oxidation can be impaired by what patients…

A

Liver Dx
Elderly
Those taking meds that inhibit oxidation–>Increase levels of the drug

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17
Q

Benzos with Oxidation mets…

A

Alprazolam (XANAX)
Clorazepate(TRANZENE)
Diazepam (VALIUM)

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18
Q

Quick Onset Short acting Benzos…

A

Diazepam (VALIUM)

Clorazepate (TRANXENE)

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19
Q

Slower Onset but Longer acting Benzos…

A

Oxazepam (SERAX)

Lorazepam (ATIVAN)

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20
Q

Benzo you should not give IM

Benzo you SHOULD give IM

A

Diazepam

Lorazepam

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21
Q

Aging on Benzos…

A

Longer elimination half life–>Lower dosing, less frequent dosing
Decreased clearance w/oxidation–>PREFERRED LORAZEPAM AND OXAZEPAM in elderly
Decreased plasma proteins lead to increased Free fraction benzos–>Increased effects
Decreased gastric acidity–>Increased rate Benzo absorption

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22
Q

Gender on Benzos…

A

ELDERLY MEN MAY REQUIRE ESPECIALLY LOW BENZO DOSE
Possible decrease in plasma conc with oxidative metabolism in premenopause women
WOMEN HAVE LONGER ELIMINATION OF LORAZEPAM AND TEMAZEPAM AND MAY NEED LESS FREQUENT DOSING
Greater drug accumulation

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23
Q

Risk factors for withdrawal seizures…

A

High Benzo Doses
Long duration of therapy
Concurrent ingestion of drugs that decrease seizure threshold

24
Q

TAPERING REGIMINE

Option one

A
  • 25% week reduction in dosage until 50% of dose

- Decrease by 1/8 every 4-7 days

25
Q

Tapering: If youve been on benzos more than 8 weeks

A

Slow taper over 2-3 weeks

26
Q

Tapering: Duration 6 months or longer

A

Taper 4-8 weeks

27
Q

Tapering: Long term use over 1 year

A

2-4 months taper

28
Q

Adjuncts to Help with Withdraw from Benzos….

A

PREGABALIN (LYRICA)

Psychotherapy interventions with tapering lead to superior outcomes

29
Q

Buspirone brand and info

A

Buspar

  • Anxiolytic with delayed onset of action need at least 2-4 weeks for efficacy
  • Monotherapy option for GAD especially uncomplicated, failed therapies, and substance abuse
  • May be initiated before Benzo taper because it may ease withdrawal
30
Q

Important CAUTION for Buspirone…

A
  • Safe profile, large increase in concentration may be clinically insignificant
  • AVOID IN MAOIS
  • CAREFUL WITH HIGH DOSE ANTIDEPRESSENTS BECAUSE OF SEROTONIN SYNDROME

Grapefruit juice and CYP3A inhibitors increase conc.

*DECREASE DOSE FOR RENAL OR HEPATIC IMPAIRMENT

31
Q

Alternatives to treatment…..

A

Hydroxyzine
Pregabalin
Atypical Antipsychotics

32
Q

Hydroxyzine

A

Vistaril

Used in a primary care setting
GAD
for Kids w/anxiety and tension

33
Q

Pregabalin

A

Lyrica

RENAL ADJUST
Similar effect of Lorazepam, Alprazolam, and Venlafaxine

34
Q

Quetapine XR

A

Seroquel XR
MONOTHERAPY

As effective as Paroxetine and Escitalopram
Earlier onset of action
BUT NOT FDA APPROVED FOR GAD

35
Q

Drug may be more likely to cause weight gain and should be avoided in preggo…

A

Paroxetine (PAXIL)

36
Q

SSRI that needs a ECG baseline…

A

Citaloprim (CELEXA)

37
Q

Paradoxical Disinhibition is what? and What population does it usually occur in and what meds?

A

Increased anxiety, irritability, or agitation
In Elderly and Children
ON BENZOS

38
Q

Common Side effects of SSRIs
Escitalopram
Paroxetine
Sertraline

A 
Jitterness Syndrome
Suicidality
NVD
Weight Gain
Sexual dysfunction
Hyponatremia
Teratogenicity--PAROXETINE cat D
DC sydrome
39
Q

Common SE of Benzos..

A 
Drowsiness/Fatigue
ANTEROGREAE AMNESIA & MEmory impairment--ESPECIALLY WITH ALCOHOL
Dependence
Withdrawl symptoms
Respiratory Depression
Psychomotor Impairment
Paradocial Disinhibition
40
Q

Pregabalin ADRs

A 
Orthostatic Hypotension
Dizziness
Peripheral Edema
Thrombocytopenia
Weight Gain
41
Q

GAD in special Pops (Substance abuse, preggo, children, elderly)

A

Fluoxetine
Sertraline
Citalopram

42
Q

Benzos with Pregnancy….

A

AVOID in 1st trimester-if necessity, lowest dose shortest period of time.

Cause: Cleft lip, palate, etc.

3rd trimester: Sedation, Withdrawal, Floppy Baby Syndrome (Hypotonia, low apgar scores, Hypothermia)

DIAZEPAM AND CHLORDIAZEPOXIDE DOC IF HAVE TO HAVE ONE DURING PREGGO

43
Q

Do not use these Benzos when Nursing…

A

Diazepam and Clonazepam

44
Q

Patients with what are at risk for accumulation of Benzos?

A

Hepatic Impairment

45
Q

Avoid this SNRI in Hepatic Impairment….

A

Duloxetine (CYMBALTA)

46
Q

Definition of Treatment Resistance….

A

Poor, partial, or lack of response with at least two antidepressants from different classes

47
Q

Strategies for pts who dont achieve appropriate response with 1st line agent…

A 
Increase dose of SSRI/SNRI
Change to diff agent in same class
Change to diff agent in diff class
Augmentation of therapy
48
Q

Sexual Dysfunction is an AE for what drugs…

A

Paroxetine and Escitalopram

Slight chance of Venlafaxine

49
Q

Increased Sweating could be experienced with…

A

Paroxetine, Duloxetine, Maybe Venlafaxine

50
Q

Agoraphobia

A

Anxiety disorder when a patient fears and avoids paces or situations that might cause panic and feelings of being trapped, helpless, or embarrassed

51
Q

Benzos for Panic Dx…

A

Alprazolam and Clonazepam

52
Q

FOR PANIC DISORDER…Benzo treatment regimen

A

SHORT TERM 4-6 weeks addition of alprazolam or clonazepam with antidepressents produces a better response but DC BZD by week 7 of therapy

53
Q

Recommended BB as an adjunctive tx with SSRI for tx resistant Panic Disorder…

A

PINDOLOL

54
Q

LESS AGGRESSIVE TAPERING OF BENZOS IN PANIC DISORDER…

A

Slow and gradual tapering over 2-4 months no more than 10% decrease per week.

55
Q

Social Anxiety disorder is treated in phases….

A

Acute Phase 4-12 weeks–>reduce symptoms, and phobic avoidances

Continuation Phase–>3-6 months Extend benefits and improved QOL

56
Q

Patients with SAD response….

A

Slow response and less completley

57
Q

Treatment that can help SAD AND Pts with Alcohol dx…

A

Paroxetine (PAXIL)

Neuro (12 decks)

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