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Pnt exam 3 > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

0
Q

two basic componenents of anxiety

A

Mental and Physical features

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1
Q

define anxiety

A

uncomfortable feeling of vague fear or apprehension accompanied by physical sensations

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2
Q

anxiety disorders differ from anxiety how

A

more intense and last for longer

development of avoidance, ritual acts, or repetitive thoughts to protect

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3
Q

length of time for symptoms to be diagnosed with generalized anxiety disorder

A

6 months

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4
Q

to be diagnosed with anxiety disorder a person must have 3+ of the following

A 
restlessness or keyed up or on edge
easily fatigued
difficulty concentrating or mind going blank
irritability 
muscle tension
sleep disturbances
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5
Q

benzodiazepines for generalized anxiety disorder

A 
alprazolam
chlordiazepoxide
clonazepam
clorazepate
diazepam
lorazepam
midazolam
oxazepam
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6
Q

brand name of alprazolam

A

xanax

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7
Q

chlordiazepoxide brand name

A

librium

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8
Q

clonazepam brand name

A

klonopin

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9
Q

clorazepate brand name

A

tranxene

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10
Q

diazepam brand name

A

valium

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11
Q

lorazepam brand name

A

ativan

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12
Q

midazolam brand name

A

versed

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13
Q

oxazepam brand name

A

serax

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14
Q

which benzos are most commonly seen in GAD

A

alprazolam
clonazepam
diazepam
lorazepam

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15
Q

alprazolam onset

A

intermediate

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16
Q

alprazolam distribution half life

A

intermediate

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17
Q

alprazolam elimination half life

A

6-20 hours

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18
Q

alprazolam oral dosage equivalency

A

1 mg

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19
Q

clonazepam oral dosage equivalency

A

0.5 mg

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20
Q

clonazepam onset

A

intermediate

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21
Q

clonazepam distribution half life

A

intermediate

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22
Q

clonazepam elimination half life

A

18-50 hours

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23
Q

diazepam oral dose equivalency

A

10 mg

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24
Q

diazepam onset

A

rapid

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25
Q

diazepam distribution half life

A

rapid

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26
Q

diazepam elimination half life

A

30-100 hours

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27
Q

lorazepam dosage equivalency

A

2 mg

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28
Q

lorazepam onset

A

intermediate

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29
Q

lorazepam distribution half life

A

intermediate

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30
Q

lorazepam elimination half life

A

10-20 hours

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31
Q

oxazepam dosage equivalency

A

30 mg

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32
Q

oxazepam onset

A

slow

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33
Q

oxazepam distribution half life

A

intermediate

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34
Q

oxazepam elimination half life

A

8-12 hours

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35
Q

oral and sublingual BZDs achieve peak plasma levels when

A

1-3 hours

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36
Q

which 3 BZDs are compounded for oral or sublingual use

A

lorazepam
alprazolam
triazolam

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37
Q

which BZDs are available in injectable forms

A

chlordiazepoxide
diazepam
lorazepam
midazolam

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38
Q

Which injectable BZD is most commonly used in pre-op

A

midazolam

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39
Q

Which 2 injectable BZDs are most commonly seen

A

lorazepam

midazolam

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40
Q

which 2 BZDs should have IM injection avoided

A

diazepam

chlordiazepoxide

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41
Q

When are IM injections of BZDs seen

A

psychomotor agitations

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42
Q

when are IV injections of BZDs seen

A

seizures and pre-op sedation

psych with acute dystonic reaction

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43
Q

which site of IM injection has better absorption

A

deltoid

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44
Q

onset of effect depends on what properties of BZDs

A

lipophilicity

high -> rapidly absorbed effect in 30-60 minutes

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45
Q

Which BZDs are highly lipophilic

A

diazepam

clorazepate

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46
Q

which BZDs are less lipophilic

A

diazepam
lorazepam
oxazepam

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47
Q

duration of effect after a single dose depends on what factor

A

distribution half life

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48
Q

duration of effect after multiple doses depends on what factor

A

elimination half life

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49
Q

Which drug is the IM DOC in psychiatry

A

lorazepam

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50
Q

which BZDs have active metabolites of little importance

A

alprazolam
triazolam
midazolam

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51
Q

which BZDs have no active metabolites

A

lorazepam
oxazepam
temazepam

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52
Q

which BZDs are choice in elderly and liver disease

A

no active metabolites
lorazepam
oxazepam
temazepam

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53
Q

drug interactions with BZDs

A

alcohol

clozapine

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54
Q

BZD interaction with alcohol

A

decreased clearance of chlordiazepoxide and diazepam

additive psychomotor inpaitment

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55
Q

management of alcohol drug interaction with BZDs

A

avoid

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56
Q

management of drug interaction between BZDs and clozapine

A

Avoid if possible

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57
Q

drug interaction between clozapine and BZDs

A

respiratory suppression

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58
Q

Common AEs of BZDs

A 
CNS depression
fatigue
sedation
psychomotor impairment
dizziness
weakness
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59
Q

BZDs effect on memory

A

anterograde amnesia

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60
Q

BZDs with the worst effects on amnesia

A

lorazepam
triazolam
midazolam

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61
Q

who is more likely to experience behavioral effects with BZDs

A

children
brain injuries
elderly

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62
Q

what behavioral effects are seen with BZDs

A

disinhibition
increased agitation
increased aggression

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63
Q

BZD pregnancy category

A

D

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64
Q

Possible outcomes of abrupt BZD d/c

A

Rebound
Relapse
Withdrawal

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65
Q

rebound definition

A

anxiety above pretreatment levels for a few days

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66
Q

relapse definition

A

anxiety back to pretreatment levels

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67
Q

common symptoms of BZD withdrawal

A 
restlessness
insomnia
decreased concentration 
nausea
decreased appetite
heart palpitations
weakness
increased acuity to sound, smell, touch, pain, 
irritability
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68
Q

symptom of extreme cases of BZD withdrawal

A

seizures

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69
Q

factors that increase the likelihood of BZD dependence

A

high potency BZDs
use 6+ months
high dose use

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70
Q

how much should BZD dose be reduced per week

A

10-25% of total daily dose

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71
Q

Advantages of BZDs

A

work immediately
take PRN
cheap
no sexual dysfunction

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72
Q

disadvantages of using BZDs

A

risk of abuse and dependence

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73
Q

buspirone brand name

A

Buspar

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74
Q

buspar active metabolite

A

yes 1

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75
Q

buspirone elimination half life

A

2.6 hours

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76
Q

buspirone dose

A

5 mg TID or 7.5 mg BID ->

10 mg TID or 15 mg BID

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77
Q

buspirone dosage range

A

20-60 mg / day in divided doses

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78
Q

buspirone pregnancy cat

A

D

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79
Q

Common AEs of buspirone

A

dizziness
lightheadedness
nausea
HA

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80
Q

buspirone drug interactions

A 
azole antifungals
clarithromycin
nefazodone
erythromycin
MAOI
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81
Q

buspirone interaction with azole antifungals and management

A

increased buspar levels

decrease dose of buspar to 2.5 mg QD

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82
Q

buspirone interaction with clarithromycin and management

A

increased buspirone levels

decrease buspar to 2.5 mgQD

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83
Q

buspirone interaction with Nefazodone and management

A

increased buspar levels

decrease dose to 2.5 mg QD

84
Q

buspirone interaction with erythromycin and managment

A

increased buspar levels

decrease dose of buspar to 2.5 mg QD

85
Q

buspirone interaction with MAOI and management

A

serotonin syndrome

contraindicated

86
Q

advantages of buspirone

A 
equally as effective as BZDs
no cognitive/psychomotor impairment
no interaction with CNS depressants
No withdrawal 
Preg Cat B
87
Q

buspirone preg cat

88
Q

disadvantages of buspirone

A

several weeks to work
Not PRN
Not effective for panic disorders
Pt will prefer BZD if already had a BZD

89
Q

SNRIs used for anxiety

A

Venlafaxine XR

duloxetine

90
Q

venlafaxine XR dose for GAD

A

37.5 mg QD x 1 week
75 mg QD x 1 week
150-225 mg QD

91
Q

duloxetine dose for GAD

92
Q

Advantages of SNRIs

A

no potential for dependence
ER form is well tolerated
Few drug-drug interactions
No dose reduction in the elderly

93
Q

disadvantages of SNRIs

A

delayed onset - 4 weeks
Not PRN
discontinuation syndrome if not tapered
sexual dysfunction

94
Q

SSRIs approved for GAD

A

paroxetine

escitalopram

95
Q

paroxetine dose for GAD

A

20 mg QD

range 20-40 mg/day

96
Q

escitalopram dose for GAD

A

10 mg QD

range 10-20 mg QD

97
Q

advantages of SSRIs

A

no potential for dependence
effective for a number of anxiety disorders
well tolerated
no psychomotor impairment

98
Q

disadvantages of SSRIs

A 
takes at least 1 month to work
high incidence of sexual dysfunction
large number of drug-drug interactions
Not PRN
expensive
discontinuation if not tapered
99
Q

TCA used for GAD

A

imipramine

100
Q

imipramine brand name

101
Q

imipramine dose

A

150-300 mg HS. must be titrated

102
Q

AEs of Imipramine

A

Anticholinergic
sedation
orthostasis

103
Q

Agents used for GAD

A 
BZD
Buspar
SNRI
SSRI
TCA
Pregabalin
Hydroxyzine
104
Q

Pregabalin brand name

105
Q

hydroxyzine brand name

A

atarax

vistaril

106
Q

pregabalin dose

A

50 mg TID

dose range 150-600 mg/day in divided doses

107
Q

Hydroxyzine dose for GAD

A

25-100 mg QID

108
Q

Hydroxyzine AEs

A 
sedation
blurred vision
dry mouth
constripation
urinary retention
NOT WELL TOLERATED
109
Q

Non-pharm treatment of GAD

A 
stress management classes
short term counseling to improve coping skills
meditation 
yoga
massage therapy 
avoid caffeine, OTC stimulants
Exercise
110
Q

1st line for GAD if no acute relief is needed

A

SNRI or SSRI

111
Q

Drug for GAD if acute relief is needed

A

BZD x 4-8 weeks

112
Q

What to use after failing a first drug in GAD

A

SNRI or SSRI

113
Q

Panic disorder is characterized by

A

Panic attacks

114
Q

Panic attacks peak in

A

10 minutes

115
Q

for a panic attack there must be 4+ of the following symptoms

A 
palpitations, pounding heart, accelerated heart rate
sweating
trembling/shaking
SOB or smothering
feeling of choking
CP or discomfort
Nausea or abdominal distress
derealization or depersonalization 
dizzy, unsteady, lightheaded, or faint
fear of losing control or going crazy
fear of dying
paresthesias
chills or heat sensations
116
Q

2 components of panic disorder

A

panic attack

fear of having a panic attack

117
Q

What medications are used to treat panic disorder

A 
TCAs
MAOIs
SSRIs
Venlafaxine
BZDs
118
Q

TCAs used for Panic disorder

A

Imipramine
Clomipramine
Desipramine

119
Q

Imipramine dose for panic disorder

A

50 mg HS
increase by 50 mg q 3 days
150 mg HS

120
Q

clomipramine dose for panic disorder

A

50 mg HS
increase by 50 mg q 3 days
150 mg HS

121
Q

Desipramine dose for panic disorder

A

50 mg HS
increase by 50 mg q 3 days
150 mg HS

122
Q

MAOI used for panic disorder

A

Phenelzine

123
Q

Phenelzine dose for Panic disorder

A

15 mg AM x 3 days
15 mg BID x 3 days
30 mg AM + 15 mg Noon
range 45-90 mg/day in divided doses

124
Q

SSRIs used for panic disorders

A

Paroxetine
Fluoxetine
Sertraline

125
Q

Paroxetine dose for panic disorder

A

10 mg x 1 week
20 mg x 1 week
40 mg QD (60 if necessary)

126
Q

Fluoxetine dose for GAD

A

10 mg x 1 week
20 mg x 1 week
40 mg x 1 week
60 mg QD if necessary

127
Q

Sertraline dose for Panic disorder

A

25 mg x 1 week
50 mg x 1 week
100 mg QD (150-200 if necessary)

128
Q

venlafaxine dose for panic disorder

A

37.5 mg QD x 1 week
75 mg QD x 1 week
150 mg QD up to 225 mg

129
Q

Advantages of using antidepressants for panic disorder

A

no risk for dependence

130
Q

disadvantages for using antidepressants for panic disorder

A

takes 4 weeks to effect
not PRN
d/c syndrome
sexual dysfunction

131
Q

BZDs used for panic disorder

A

Alprazolam

Clonazepam

132
Q

Alprazolam dose for panic disorder

A

0,5 mg QID increase to 4-12 mg /day

133
Q

dose of Alprazolam XR for panic disorder

A

0.5 mg QD
increase 0.5 mg q 3-4 days to
1-10 mg QD

134
Q

dose of clonazepam for panic disorder

A

0.5 mg BID up to 3 mg BID

135
Q

advantages of using BZDs for panic disorder

A

work rapidly

PRN

136
Q

disadvantages of using BZDs for panic disorder

A

Risk of abuse/dependence

137
Q

Length of treatment for panic disorder

A

panic free + 12 months

138
Q

non-pharm treatments for panic disorder

A

cognitive behavior therapy

exercise

139
Q

drug if acute relief is needed for panic disorder

A

BZD x 2-4 weeks + SSRI/Venlafaxine

140
Q

1st line agents for panic disorder

A

SSRi or venlafaxine

141
Q

drug given after failing one drug for panic disorder

A

another SSRI or venlafaxine

142
Q

social phobia is characterized by

A

intense irrational fear of scrutiny or evaluation by others in social situations due to anticipation of humiliation or being made feel ridiculous

143
Q

Age of onset of social anxiety disorder

A

grade school

144
Q

Drugs for social anxiety disorder

A 
MAOI
SSRI
SNRI
Beta blockers
BZDs
gabapentin
pregabalin
tramadol
145
Q

MAOI used for social anxiety disorder

A

Phenelzine

146
Q

Phenelzine dose for social anxiety disorder

A

15 mg AM x 3 days

45-90 mg /day in divided doses

147
Q

SSRIs used for social anxiety disorder

A

paroxetine
sertraline
fluvoxamine CR

148
Q

paroxetine dose in social anxiety disorder

A

30-50 mg /day

149
Q

sertraline dose in social anxiety disorder

A

100-200 mg /day

150
Q

fluvoxamine CR dose in social anxiety disorder

A

100-300 mg /day

151
Q

SNRI used for social anxiety disorder

A

venlafaxine

152
Q

venlafaxine dose for social anxiety disorder

A

37.5 mg QD

dose range 75-225 mg /day

153
Q

how long is an adequate trial in social anxiety disorder

154
Q

which beta blockers are used for social anxiety disorder

A

propranolol

atenolol

155
Q

propranolol dose in social anxiety disorder

A

10-30 mg QD

156
Q

beta blockers help with what in social anxiety disorder

A

symptoms (HR, tremor, blushing)

NOT PSYCH

157
Q

atenolol dose in social anxiety disorder

A

50-100 mg QD

158
Q

BZD used in social anxiety disorder

A

Clonazepam

159
Q

clonazepam dose in social anxiety disorder

A

0.5 mg BID

dose range 1-4 mg/day

160
Q

gabapentin dose for social anxiety disorder

A

300 mg BID

dose range 900-3600 mg/day in divided doses

161
Q

Pregabalin dose in social anxiety disorder

A

100 mg TID up to 600 mg / day

162
Q

Buspar dose for social anxiety disorder

A

15-30 mg/day

163
Q

1st line agents for social anxiety disorder

A

SSRI or venlafaxine XR

164
Q

length of treatment for social anxiety disorder

165
Q

5 subtypes of specific phobias

A 
animal (spider, snake) 
Natural environment (thunder) 
blood-injection
situational (elevators, tunnels, bridges) 
Other
166
Q

Non-pharm treatment for specific phobia

A

avoid object

systematic desenzitizaiton

168
Q

define specific phobia

A

persistant fear of a circumscribed object or situation

169
Q

define obsessions

A

intrusive or recurrent thought, image, or impulse that is anxiety provoking to the person and that cannot be ignored or suppressed voluntarily.

170
Q

Define compulsions

A

Behavior or ritual that is performed in a repetitive or stereotypic way which is designed to reduce anxiety or prevent a future event.

171
Q

treatment options for OCD

A 
clomipramine
fluoxetine
fluvoxamine
paroxetine
sertraline
172
Q

clomipramine brand name

173
Q

clomipramine dose for OCD

A

25 mg HS -> 100 mg daily

max 250 mg/day

174
Q

Fluoxetine dose for OCD

A

20 mg/day -> 60-120 mg/day

175
Q

Fluvoxamine dose for OCD

A

50 mg hs increase by 50 mg every 4-7 days to max 300 mg/day in 2 divided doses

176
Q

Paroxetine dose for OCD

A

10-20 mg/day increased by 10 mg QW up to 50mg/day

177
Q

Sertraline dose for OCD

A

25-50 mg/day increased by 50 mg QW or QOW up to 200mg/day

178
Q

nonpharm treatment for OCD

A

behavioral modificiation

Cognitive behavior therapy

179
Q

Define PTSD

A

characteristic symptoms after exposure to 1+ traumatic events

180
Q

Nonpharm treatment for PTSD

A

CBT - Treatment of choice

Eye movement Desensitization and Reprocessing

181
Q

Pharm treatments for PTSD

A 
TCAs
MAOIs
SSRIs
antidepressants
Anxiolytics 
Adrenergic inhibitors
182
Q

TCAs used for PTSD

A

imipramine

amitriptyline

183
Q

imipramine dose for PTSD

A

50-300 mg/day

184
Q

amitriptyline dose for PTSD

A

50-300 mg/day

185
Q

MAOIs used for PTSD

A

Phenelzine

186
Q

Phenelzine dose for PTSD

A

15-90 mg/day

187
Q

SSRIs used for PTSD

A 
citalopram 
fluvoxamine
fluoxetine
Paroxetine
Sertraline
188
Q

citalopram dose for PTSD

A

20-60 mg/day

189
Q

fluvoxamine dose for PTSD

A

100-250 mg/day

190
Q

Fluoxetine dose for PTSD

A

20-80 mg/day

191
Q

Paroxetine dose for PTSD

192
Q

Sertraline dose for PTSD

A

25 mg QD x 1 week, then 50 mg qd

range 50-200 mg/day

193
Q

other antidepressants used for PTSD

A 
bupropion
mirtazepine
nefazodone
trazodone
venlafaxine
194
Q

bupropion dose for PTSD

A

200-450 mg/day

195
Q

mirtazepine dose for PTSD

A

15-45 mg/day

196
Q

nefazodone dose for PTSD

A

200-600 mg/day

197
Q

Trazodone dose for PTSD

A

50-400 mg/day

198
Q

Venlafaxine dose for PTSD

A

75-225 mg/day

199
Q

Anxiolytic agents for PTSD

A

buspirone
alprazolam
clonazepam

200
Q

buspirone dose for PTSD

A

15-60 mg/day

201
Q

Alprazolam dose for PTSD

A

0.25 - 6 mg/day

202
Q

Clonazepam dose for PTSD

A

0.5 - 4 mg/day

203
Q

Adrenergic inhibitors used for PTSD

A

clonidine
guanfacine
prazosin
propranolol

204
Q

clonidine dose for PTSD

A

0.2-6 mg/day

205
Q

guanfacine dose for PTSD

A

0.5-3mg HS

206
Q

prazosin dose for PTSD

A

2-10 mg/day

207
Q

propranolol dose for PTSD

A

40-160mg/day in divided doses

208
Q

1st line treatment for PTSD

209
Q

length of treatment for PTSD

A

12 months.

Pnt exam 3 (8 decks)

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