Anxiety Disorder

Question 1

What medications can cause anxiety?

Answer 1

Albuterol, antipsychotics, bupropion, caffeine, decongestants, illicit drugs, levothyroxine, steroids, stimulants, theophylline

Question 2

What medications are used first-line in anxiety?

Answer 2

SSRIs and SNRIS

Escitalopram, Fluoxetine, Paroxetine, Sertraline, Duloxetine, Venlafaxine

Question 3

What medications are used second line in anxiety?

Answer 3

Buspirone
TCA (amitriptyline, imipramine, nortriptyline)
Hydroxyzine
Pregabalin (C-V)
Gabapentin
Propranolol in special situations

Question 4

Buspirone CI, notes

Answer 4

CI: use with MAOi
Notes: no potential for abuse, tolerance, or physiological dependence
Risk of serotonin syndrome when use with other serotonergic meds

Question 5

When are benzos used for anxiety?

Answer 5

For fast relief of symptoms

NOT preferred for anxiety

Question 6

Benzo MOA

Answer 6

Enhance GABA causing CNS depression

Question 7

How long should benzos be used for anxiety? Why?

Answer 7

1-2 weeks d/t risk of dependence

If used longer need to be tapered slowly to prevent withdrawal symptoms

Question 8

What are the LOT benzos and who are they preferred in?

Answer 8

Lorazepam, Oxazepam, Temazepam preferred in
Elderly
Liver impairment

Question 9

Which benzos are preferred in Anxiety? Sleep? Seizures?

Answer 9

Anxiety: Clonazepam, lorazepam, alprazolam, diazepam
Sleep: lorazepam, temazepam
Seizures: injectable BZDs or diazepam

Question 10

Benzodiazepine BBW, CI, warnings, SE

Answer 10

BBW: use with opioids can result in sedation, respiratory depression, coma, death
CI: severe liver disease
Warnings: Physiological dependence and tolerance, CNS depression, anterograde amnesia, potential for abuse, safety risks in pts >65 yo, pregnancy crosses placenta
SE: Somnolence, dizziness, ataxia

Question 11

Lorazepam brand name

Answer 11

Ativan

Question 12

Diazepam brand name

Answer 12

Valium

Question 13

Benzo antidote

Answer 13

Flumazenil