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Exam 6 > Anxiety ClinMed and Pharm > Flashcards

Anxiety ClinMed and Pharm Flashcards

1
Q

Definition of anxiety

A

fear or apprehension out of proportion to the situation

stress is ok, but anxiety is when it is more than needed

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2
Q

The function of anxiety and arousal systems is to increase ______ to a possibly dangerous situation

A

alertness

it ups motivation to get out of the danger

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3
Q

Anxiety disorder defined by:
excessive worry about life, worry uncontrolled, restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances
Causes significant impairment to functioning. not due to substance or another psych condition

A

General anxiety disorder

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4
Q

GAD has _____ rates in females and <30 years old. Onset is typically by _____

A

higher, early 20s

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5
Q

What is the pathophysiology of GAD

A

GABAergic, serotonergic, norandrenergic in frontal/limbic lobes

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6
Q

Other things on the DDx for GAD

A

substance induced, other anxiety disorders, adjustment disorder

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7
Q

Treatment of GAD gold standard is ____ and ____

A

SSRI/SNRI and CBT

CBT= antecedents, beliefs, consequences. ID the maladaptive thoughts and create healthy alternatives

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8
Q

Medication that is rapidly effective for GAD but also not recommended

A

Benzodiazepines
tolerance, dependance, relapse in SUD, falls, sedation, worsened cognition, lethal with EtOH, HARD to stop. promotes avoiding anxiety symptoms

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9
Q

For GAD: ________ are the medication used but it can takes weeks to work. ___ and ____ are two commonly started

A

Antidepressants

low dose trazodone, hydroxyzine

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10
Q

Name that anxiety disorder:
fear about social situations, social interactions, being observed, and performing in front of others. Fears rejection. Social situations are avoided.

A

Social phobia

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11
Q

Social phobia has prevalence of ___%, affecting males/females ___, ____ have another psych disorder

A

13%, equally, 50%.

increased SUD risk, familial bc dopa

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12
Q

What is the treatment for social phobia?

A

SSRI/SNRI, β blockers, psychotherapy

lack of improvement if fears not confronted

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13
Q

Are panic attacks a disorder or a symptom?

A

symptom

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14
Q

What symptoms are associated with panic attacks

A

palpitations, sweating, trembling shaking, SOB, feeling of choking, nausea, dizziness, chills, parenthesis, fear of losing control, fear of dying

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15
Q

_____ is a sudden onset 5-60 minute duration symptom that can occur in the context of any anxiety disorder or other conditions

A

Panic Attack

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16
Q

Name that anxiety disorder
recurrent unexpected panic attacks, not substance, not explained by another mental condition
1 of: persistent concern or worry about another panic attack or significant maladaptive change in behavior

A

Panic disorder

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17
Q

Panic disorder lifetime prevalence of __ in women and __ in men.
Onset is ___

A

5, 2
mid 20s.
first one usually to ED but then becomes chronic illness with symptom fluctuation.
increased risk of death from SUD or depression

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18
Q

Panic disorder comorbidities include (medical conditions)

A

IBS, HTN, mitral valve prolapse, fibromyalgia, chronic fatigue, migraine, asthma, allergic rhinitis, sinusitis

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19
Q

Panic disorder can be hereditary, first degree relative up to __%

A

20

higher concordance with twins

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20
Q

Panic disorder treatment is to combine ___ and ___. Second line is _____, ______, and ______. Avoid caffeine

A

SSRI/SNRI, psychotherapy

β blocker, MAOIs, TCAs

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21
Q

Why are benzodiazepines unnecessary for panic disorders?

A

risks and the attack usually subsides before the med becomes bioavailable

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22
Q

Name that anxiety disorder:
Fear of inability escape quickly (public, open spaces, enclosed spaces, standing in lines), fear of being trapped. Can be comorbid with panic disorder

A

Agoraphobia

sitation cause anxiety-> avoid situation ->impairment

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23
Q

_____ and ______ stressful situations reinforces the anxiety

A

avoidance and fleeing. Treatment is aimed at staying in the stressful situations

24
Q

When is an appropriate use of benzodiazepines

A

before imaging/radiation/flying, alcohol detox, anesthesia, seizures

25
Q

Adequate treatment trial for GAD on SSRIs is _____.
If response then keep for ____
If no response then _____

A

4-6 weeks.
1 year
switch to another SSRI

26
Q

_____ can be taken for GAD short term/as needed

A

Benzodiazepines. If cannot take those bc SUD, concurrent CNS depressants, then take hydroxyzine

27
Q

Second line treatments for SUD include

A

benzodiazepines, buspirone, pregabalin, quetiapine.

As needed meds -> lorazepam, hydroxyzine

28
Q

Benzodiazepines mechanism is binding ____ and _____ allosterically on post synaptic ____ -> enhances GABA CNS inhibitory

A

α and γ
GABA-A
increases frequency of CL ion channel opening
modulates neuronal excitability through amygdala and cortico-striato-thalamo-cortical loop-> helps anxiety symptoms

29
Q

GAD
α 1 receptors target _____
α 2 receptors target _____

A

sedation

anxiolysis

30
Q

BZ receptors are _____ so it can treat many physical symptoms such as ________

A

nonselective, restlessness, muscle tension, irritability, insomnia

31
Q

Benzodiazepines anxiolytic effect can be seen within _______.

A

30-60 minutes

32
Q

What are the 4 FDA approved benzodiazepines? What is the difference?

A

lorazepam, clonazepam, alprazolam, diazepam.

Pharmacokinetic differences.

33
Q

Benzodiazepines are highly (lipophilic/hydrophilic)

A

lipophilic

34
Q

Benzodiazepines are largely metabolized by _____

A

CYP450-> 3A4 and 2C19

Caution in: old ppl, decreased liver, drug drug, active metabolites

35
Q

_______ is a benzo that goes through glucuronidation to inactive metabolites (this makes it safer)

A

lorazepam

36
Q

Benzodiazepines with rapid onset of effect risk _____, ______, unpleasant feeling of loss of control

A

euphoria, excitement

37
Q

The most common adverse effects of benzodiazepines are _______, _______, psychomotor impairment, and ataxia.

A

drowsiness, sedation

this can stay around for a few days then tolerance

38
Q

Do not give benzodiazepines to _______ or _______ because there is a risk of confusion, disorientation, delirium, and risk of falls

A

geriatric patients or pts with cognitive disorder (beer’s criteria)

39
Q

There is an increased risk of ______ with benzodiazepine use. This is dose dependent and also make sense why you would give benzos to someone right before an invasive procedure

A

anterograde amnesia

40
Q

Benzodiazepines (can/cannot) be abused psychologically and physiologically

A

can. overuse leads to dependence and withdrawal

There is respiratory depression and should be avoided with other depressants (opioids, alc)

41
Q

Benzodiazepines are pregnancy category __

A

D

42
Q

Withdrawal from benzodiazepines is the original symptoms but worse. The thing to really watch for is ______.
Onset of withdrawal depends on ______

A 
seizures.
half life (may need a long taper w longer bz use)
43
Q

Is it likely to OD on benzodiazepine alone? why not?

A

no, it has a wide therapeutic index.

ODs happen when combined with other CND depressants

44
Q

________ is a competitive benzodiazepine receptor antagonist (α and γ)-> reverse binding of BZ

A

Flumaznil

use cautiously because could cause seizure

45
Q

Buspirone (Buspar) MOA: _________ at pre and post synaptic 5HT-1A receptors-> overtime this will lead to 5HT receptor _______

A

partial agonist

downregulation

46
Q

Is buspirone a controlled substance? Why not?

A

not a controlled substance. There is no abuse or dependence, hypnotic, euphoric effect, or withdrawal.

47
Q

Who would buspirone be indicated for in GAD?

A

Patients with SUD, older, failed other treatments, pregnancy category B

48
Q

Why wouldn’t you use buspirone on everyone for GAD?

A

inconsistent efficiency. It is less effective than BZ. slow onset (4-6 weeks) and short half life (3x daily)

49
Q

The main medications used for Panic Disorder are ____. ______ can be used for breakthrough panic attacks

A

SSRIs (fluoxetine, paroxetine, sertraline) or SNRI (venlafaxine)
Benzodiazepines (might not work bc not bioavailable yet)

50
Q

Acute treatment phase for panic disorder is ______. Duration of treatment is recommended _______

A

1-3 months

12-24 months

51
Q

The main medications used for social anxiety disorder are______. Maintain appropriate treatment for ______

A

SSRIs (paroxetine, sertraline) and venlafaxine. Benzos used as needed
6-12 months
if not enough response, can add buspirone or clonazepam

52
Q

Full remission for OCD is ____ with medication.

A

rare

Partial remission is best bet

53
Q

The first and second line treatments for OCD is ________. The third line treatment is _______ because of greater anticholinergic adverse effects

A

SSRIs!!
Clomipramine, a tricyclic antidepressant
DO NOT USE BENZOS

54
Q

For OCD, _______ is combined with SSRIs in patients with tic disorder

A

atypical antipsychotics

55
Q

Mediation trial for OCD is _______. Prescribed max dose for _____.
Treat for ______ years

A

8-12 weeks, 4-6 weeks. OCD responds well to high doses of SSRI
1-2 years

56
Q

Firstline for PTSD treatment is ______, start 3-4 weeks after trauma in combination with ______.

A

Antidepressants, psychotherapy

trial 8-12 weeks, max dose 4-6 weeks. NO BENZOS

57
Q

Additional medication for residual symptoms in PTSD can be used. For sleep difficulties use _____. For anger, intrusive thoughts, and hypervigilance use _______.

A 
Prazosin (HTN drug)
Atypical antipsychotics (lamotrigine, risperidone, quetiapine)

Exam 6 (14 decks)

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