Anxiety and Mood Disorders

Question 1

discrete period of intense fear of being places or situations from which escape may be difficult or embarrassing

Answer 1

Panic Disorder

Question 2

Persistent unwanted thoughts and/or repetitive behaviors

Answer 2

OCD

Question 3

Chronic tx of most anxiety disorders usually

Answer 3

SSRI (maybe SNRI)

tricyclics have more side effects and time to onset

Question 4

Benzodiazepines for anxiety include

Answer 4

alprazolam (Xanax)
clordiazepoxide (Librium)
clonazepam (Klonopin)
clorazepate (tranxene-T)
diazepam (valium)
lorazepam (Ativan)
oxazepam

Question 5

MOA for benzodiazepines

Answer 5

benzodiazepine receptor binding making it more prone for GABA binding and opening Cl flow

Question 6

ADRs of benzos

Answer 6

CNS: ataxia, cog dysfx, depression, dizzy, drowsy, fatigue, irritable, memomry impairment, sedation
Endocrine: decreased libido
GI: appetite changes, wt gain/loss
Resp: nasal congestion

Question 7

Best benzo for skeletal muscle relaxation

Answer 7

diazepam

Question 8

Benzos for amnestic effect

Answer 8

triazolam and midazolam (Versed)

Question 9

Benzo for status epilepticus

Answer 9

Lorazepam

Question 10

Benzo for petit mal (Lennox-Gastaut variant)

Answer 10

Clonazepam

Question 11

Dose a benzo for anxiety/ panic disorder

Answer 11

Alprazolam 0.5mg every 8 hours

Question 12

non-benzo for anxiety

Answer 12

buspirone (BuSpar)

Question 13

MOA buspirone

Answer 13

serotonin receptor partial agonist

D2 D3 D4 dopamine antagonist

Question 14

ADRs of buspirone

Answer 14

Rare
CNS: dizzy, confusion, anger/hostility
GI: nausea

Question 15

Dose buspirone

Answer 15

Buspirone 15mg twice a day

Question 16

Lithium salts include

Answer 16

Lithium carbonate

Lithium citrate

Question 17

ADRs of lithium salts

Answer 17

CNS: fine postural hand tremor, electroencephalogram changes
Renal: polyuria & compensatory polydipsia
Endocrine: thyroid enlargement
Cardiac: rare but careful with elderly pts with hx arrhythmias

Question 18

Do lithium salts need renal adjustments?

Answer 18

Yes and thiazide diuretics and newer NSAIDS reduce clearance

Question 19

Lithium salts are approved for

Answer 19

Bipolar disorder and mania in bipolar disorder

Question 20

Dose a lithium salt

Answer 20

Lithium carbonate ER tablet

600mg tablet twice a day

Question 21

What is the therapeutic range for lithium salts?

Answer 21

04-1.2 mEq/L

Question 22

If lithium blood level low but s/s improvement dose should be

Answer 22

the same!

Question 23

ADRs of valproic acid

Answer 23

Wt gain
n/v
Hair loss
easy bruising
life-threatening pancreatitis
avoid if risk of pregnancy/ younger women (teratogen)
suicide risk warning

Question 24

Valproic acids for bipolar disorder

Answer 24

Depakote, Depakote ER, stavzor

Question 25

Who can best renally clear valproic acid?

Answer 25

Children <10

Question 26

What should be monitored when on valproic acid?

Answer 26

Liver function testing monthly to start then every 3-4 months

Question 27

Dose a valproic acid derivative for bipolar disorder

Answer 27

Depakote ER 500 mg | Three tablets once daily

Question 28

Anticonvulsants for acute manic episode with bipolar disorder

Answer 28

Carbamazepine/ Equetrol

Question 29

ADRs of Equetrol

Answer 29

Ataxia, dizzy, somnolence, HA Heme: agranulocytes, aplastic anemia, leukopenia Derm: SJS Suicidal risk warning

Question 30

Carbamazepine/ Equetrol drug interxns

Answer 30

affect multiple drugs. some rise, some fall Major CYP3A4 substrate Strong inducer of CY1A2, CYP2B6, CYP2C19, CYP2C8, CYP2C9, 3A4, and P-glycoprotein

Question 31

Dose a carbamazepine for bipolar mania

Answer 31

Equetro 400mg twice a day

Question 32

If severly ill with acute mania

Answer 32

lithium + antipsyc | valproate + antipsyc (not ziprasidone)