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Therapeutics II > anxiety and ADHD > Flashcards

anxiety and ADHD Flashcards

1
Q

indications for bzd

A
  • anxiolytic
  • muscle relaxant
  • anticonvulsant
  • sedative- hypnotic
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2
Q

how do bzds work

A
  • enhance GABA

- cross reacti with etoh

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3
Q

list the bzd drugs

A
  • triazolam
  • clonazepam
  • alprazolam
  • lorazepam
  • diazepam
  • oxazepam
  • chloriazepoxide
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4
Q

bzd ADRs

A
  • sedation
  • cognitive impairment- permanent
  • ataxia/ incoord- esp in elderly
  • respiratory distress
  • anterograde amnesia
  • paradoxical agitation- high doses
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5
Q

bzd withdrawal

A
  • much more severe than SSRIs
  • occurs after 2 weeks of use
  • insomnia
  • rebound anxiety
  • seizures
  • disinhibition in pts predisposed
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6
Q

what is a sign of bzd abuse

A
  • dose escalation

- do not dev tolerance to anxiolytic or muscle relaxant effects

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7
Q

how should to taper to d/c long term bzds

A
  • slowly reduce dose over 3-6 months
  • start initiating SSRI/ SNRI for anxiety
  • consider melatonin for sleep
  • consider pregabalin for withdrawal/ anxiety/ sz if taper is fast
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8
Q

generalized anxiety disorder (GAD)

A
  • constant low level of anxiety
  • often comorbid with MDD
  • higher rates of CVD and IBS
  • females > males
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9
Q

tx options for acute GAD

A
  • SSRI**

- TCA

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10
Q

tx options for maintenance of GAD

A
  • SSRI**
  • SNRI
  • busprione
  • can consider pregabalin but high abuse risk
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11
Q

what SSRI has best initial response for anxiety

A
  • fluoxetine
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12
Q

what SSRI has best tolerability for anxiety

A
  • sertraline

- preferred as first line

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13
Q

buspirone

A
  • brand: buspar
  • 5HT1a partial agonist
  • no sedation, cognitive impairment, respir depression, dependence, or withdrawal like with BZDs
  • lacks abuse potential
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14
Q

panic attack

A
  • pd of intense fear in which sx dev abruptly
  • reach peak within minutes
  • fearful for life
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15
Q

acute phase tx for panic attack

A
  • SSRI*
  • TCA
  • venlafaxine
  • BZD for break through if pt has been edu on prodromal sx
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16
Q

ppx of panic attacks

A
  • SSRI*

- TCA

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17
Q

misc. anxiolytic drugs

A
  • antiepileptics
  • atypical antipsychotics
  • hydroxyzine
  • propranolol
  • clonidine
18
Q

antiepileptics as anxiolytics

A
  • used for GAD only
  • not strong enough for panic
  • not as well tolerated or as effective as serotonin agents
  • pregabalin, gabapentin
  • tiagabine
  • topiramate
19
Q

atypical antipsychotics as anxiolytics

A
  • only as add on to SSRI for panic

- NOT to be used in GAD

20
Q

causes of ADHD

A
  • genetic
  • reduced DA and NE
  • leads to delayed brain maturation by 2-3 years, catch up by about 18
21
Q

methylphenidate and dexmethylpenidate

A
  • stimulants
  • mainly impacts DA, less impact on NE
  • quick onset within first day
  • avail as many dif forms- avoid transdermal patch
  • NO impact on tics
22
Q

amphetamines

A
  • stimulants
  • mainly impacts NE, some DA, MAO, alpha and beta
  • quick onset within first few days of dosing
  • avail as many dif dosing forms
  • may worsen preexisting tic or dev new onset tic
  • more risk of drug interactions
23
Q

ADRs of stimulants

A
  • insomnia
  • reduced appetite
  • stomach ache
  • HA
  • irritability
  • generally less ADRs with extended release
  • low increase in HR and BP- monitor at each visit
24
Q

how is dosing preferred for stimulants

A
  • QD with longer acting agents

- may add short acting agent for intermittent evening activities

25
Q

what disease states should you be cautious using stimulants in

A
  • CVD
  • psychosis
  • glaucoma
26
Q

stimulants and CV risk

A
  • untreated ADHD more likely to abuse cigarettes and substances
  • stimulants dont show worsened CV risk
27
Q

simulants and seizures

A
  • NOT a c/i to use

- best data to support methylphenidate

28
Q

what impact does DA have on ADHD sx

A
  • dont pay attention to distractions around you
29
Q

what impact does NE have on ADHD sx

A
  • increased attention to task
30
Q

stimulant risk of abuse

A
  • kids with ADHD more likely to have an abuse problem than those without
  • BUT kids adequately treated with stimulant for ADHD have same abuse rates as non ADHD kids
31
Q

stimulant effect on growth

A
  • 2 cm shorter and 2.7 kg lighter at 3 years
  • no difference by ten years
  • most effect in first few mo
  • consider d/c on weekends and summer
32
Q

atomoxetine

A
  • blocks reuptake of NE, small increase in DA
  • quick onset, can have cont improvement for up to 6 weeks
  • intial slowed growth but no dif by 36 mo
  • usu dosed qAM but may need afternoon dose
33
Q

ADRs of atomoxetine

A
  • GI upset
  • dry mouth
  • reduced apetitie
  • insomnia
  • erectile dysfunction
34
Q

drug interactions of atomoxetine

A
  • MAOIs
  • SNRIs
  • alpha 1 antagonists
  • vasoconstrictors
  • albuterol
35
Q

stimulants vs atomoxetine

A
  • stim ave small efficacy advantage
  • atomoxetine safter for pts with SUD
  • atomoxetine may be better for ADHD + anxiety
36
Q

guanfacine

A
  • alpha 2 agonist
  • overall not as effective as stimulants
  • can be useful adjunct
  • takes 4 weeks for full effect
  • safe in tics
  • consider for comorbid oppositional defiant disorder or conduct disorder
37
Q

ADRs of guanfacine

A
  • decreased BP and HR
  • sedation
  • somnolence
  • fatigue
38
Q

clonidine

A
  • similar to guanfacine but less specific
  • greater decreased in BP
  • shorter half life
39
Q

what drugs is preferred in tics + ADHD

A
  • methlyphenidate first line

- alpha 2 agonists reduce tics but not as effective for ADHD

40
Q

what ADHD drugs worsen tics

A
  • amphetamines
41
Q

what ADHD drugs have no effect on tics

A
  • atomoxetine

Therapeutics II (8 decks)

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