Anxiety Disorders Flashcards
0
Q
two basic componenents of anxiety
A
Mental and Physical features
1
Q
define anxiety
A
uncomfortable feeling of vague fear or apprehension accompanied by physical sensations
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
3
Q
length of time for symptoms to be diagnosed with generalized anxiety disorder
A
6 months
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
5
Q
benzodiazepines for generalized anxiety disorder
A
alprazolam chlordiazepoxide clonazepam clorazepate diazepam lorazepam midazolam oxazepam
6
Q
brand name of alprazolam
A
xanax
7
Q
chlordiazepoxide brand name
A
librium
8
Q
clonazepam brand name
A
klonopin
9
Q
clorazepate brand name
A
tranxene
10
Q
diazepam brand name
A
valium
11
Q
lorazepam brand name
A
ativan
12
Q
midazolam brand name
A
versed
13
Q
oxazepam brand name
A
serax
14
Q
which benzos are most commonly seen in GAD
A
alprazolam
clonazepam
diazepam
lorazepam
15
Q
alprazolam onset
A
intermediate
16
Q
alprazolam distribution half life
A
intermediate
17
Q
alprazolam elimination half life
A
6-20 hours
18
Q
alprazolam oral dosage equivalency
A
1 mg
19
Q
clonazepam oral dosage equivalency
A
0.5 mg
20
Q
clonazepam onset
A
intermediate
21
Q
clonazepam distribution half life
A
intermediate
22
Q
clonazepam elimination half life
A
18-50 hours
23
Q
diazepam oral dose equivalency
A
10 mg
24
diazepam onset
rapid
25
diazepam distribution half life
rapid
26
diazepam elimination half life
30-100 hours
27
lorazepam dosage equivalency
2 mg
28
lorazepam onset
intermediate
29
lorazepam distribution half life
intermediate
30
lorazepam elimination half life
10-20 hours
31
oxazepam dosage equivalency
30 mg
32
oxazepam onset
slow
33
oxazepam distribution half life
intermediate
34
oxazepam elimination half life
8-12 hours
35
oral and sublingual BZDs achieve peak plasma levels when
1-3 hours
36
which 3 BZDs are compounded for oral or sublingual use
lorazepam
alprazolam
triazolam
37
which BZDs are available in injectable forms
chlordiazepoxide
diazepam
lorazepam
midazolam
38
Which injectable BZD is most commonly used in pre-op
midazolam
39
Which 2 injectable BZDs are most commonly seen
lorazepam
| midazolam
40
which 2 BZDs should have IM injection avoided
diazepam
| chlordiazepoxide
41
When are IM injections of BZDs seen
psychomotor agitations
42
when are IV injections of BZDs seen
seizures and pre-op sedation
| psych with acute dystonic reaction
43
which site of IM injection has better absorption
deltoid
44
onset of effect depends on what properties of BZDs
lipophilicity
| high -> rapidly absorbed effect in 30-60 minutes
45
Which BZDs are highly lipophilic
diazepam
| clorazepate
46
which BZDs are less lipophilic
diazepam
lorazepam
oxazepam
47
duration of effect after a single dose depends on what factor
distribution half life
48
duration of effect after multiple doses depends on what factor
elimination half life
49
Which drug is the IM DOC in psychiatry
lorazepam
50
which BZDs have active metabolites of little importance
alprazolam
triazolam
midazolam
51
which BZDs have no active metabolites
lorazepam
oxazepam
temazepam
52
which BZDs are choice in elderly and liver disease
no active metabolites
lorazepam
oxazepam
temazepam
53
drug interactions with BZDs
alcohol
| clozapine
54
BZD interaction with alcohol
decreased clearance of chlordiazepoxide and diazepam
| additive psychomotor inpaitment
55
management of alcohol drug interaction with BZDs
avoid
56
management of drug interaction between BZDs and clozapine
Avoid if possible
57
drug interaction between clozapine and BZDs
respiratory suppression
58
Common AEs of BZDs
```
CNS depression
fatigue
sedation
psychomotor impairment
dizziness
weakness
```
59
BZDs effect on memory
anterograde amnesia
60
BZDs with the worst effects on amnesia
lorazepam
triazolam
midazolam
61
who is more likely to experience behavioral effects with BZDs
children
brain injuries
elderly
62
what behavioral effects are seen with BZDs
disinhibition
increased agitation
increased aggression
63
BZD pregnancy category
D
64
Possible outcomes of abrupt BZD d/c
Rebound
Relapse
Withdrawal
65
rebound definition
anxiety above pretreatment levels for a few days
66
relapse definition
anxiety back to pretreatment levels
67
common symptoms of BZD withdrawal
```
restlessness
insomnia
decreased concentration
nausea
decreased appetite
heart palpitations
weakness
increased acuity to sound, smell, touch, pain,
irritability
```
68
symptom of extreme cases of BZD withdrawal
seizures
69
factors that increase the likelihood of BZD dependence
high potency BZDs
use 6+ months
high dose use
70
how much should BZD dose be reduced per week
10-25% of total daily dose
71
Advantages of BZDs
work immediately
take PRN
cheap
no sexual dysfunction
72
disadvantages of using BZDs
risk of abuse and dependence
73
buspirone brand name
Buspar
74
buspar active metabolite
yes 1
75
buspirone elimination half life
2.6 hours
76
buspirone dose
5 mg TID or 7.5 mg BID ->
| 10 mg TID or 15 mg BID
77
buspirone dosage range
20-60 mg / day in divided doses
78
buspirone pregnancy cat
D
79
Common AEs of buspirone
dizziness
lightheadedness
nausea
HA
80
buspirone drug interactions
```
azole antifungals
clarithromycin
nefazodone
erythromycin
MAOI
```
81
buspirone interaction with azole antifungals and management
increased buspar levels
| decrease dose of buspar to 2.5 mg QD
82
buspirone interaction with clarithromycin and management
increased buspirone levels
| decrease buspar to 2.5 mgQD
83
buspirone interaction with Nefazodone and management
increased buspar levels
| decrease dose to 2.5 mg QD
84
buspirone interaction with erythromycin and managment
increased buspar levels
| decrease dose of buspar to 2.5 mg QD
85
buspirone interaction with MAOI and management
serotonin syndrome
| contraindicated
86
advantages of buspirone
```
equally as effective as BZDs
no cognitive/psychomotor impairment
no interaction with CNS depressants
No withdrawal
Preg Cat B
```
87
buspirone preg cat
B
88
disadvantages of buspirone
several weeks to work
Not PRN
Not effective for panic disorders
Pt will prefer BZD if already had a BZD
89
SNRIs used for anxiety
Venlafaxine XR
| duloxetine
90
venlafaxine XR dose for GAD
37.5 mg QD x 1 week
75 mg QD x 1 week
150-225 mg QD
91
duloxetine dose for GAD
60 mg QD
92
Advantages of SNRIs
no potential for dependence
ER form is well tolerated
Few drug-drug interactions
No dose reduction in the elderly
93
disadvantages of SNRIs
delayed onset - 4 weeks
Not PRN
discontinuation syndrome if not tapered
sexual dysfunction
94
SSRIs approved for GAD
paroxetine
| escitalopram
95
paroxetine dose for GAD
20 mg QD
| range 20-40 mg/day
96
escitalopram dose for GAD
10 mg QD
| range 10-20 mg QD
97
advantages of SSRIs
no potential for dependence
effective for a number of anxiety disorders
well tolerated
no psychomotor impairment
98
disadvantages of SSRIs
```
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
TCA used for GAD
imipramine
100
imipramine brand name
tofranil
101
imipramine dose
150-300 mg HS. must be titrated
102
AEs of Imipramine
Anticholinergic
sedation
orthostasis
103
Agents used for GAD
```
BZD
Buspar
SNRI
SSRI
TCA
Pregabalin
Hydroxyzine
```
104
Pregabalin brand name
lyrica
105
hydroxyzine brand name
atarax
| vistaril
106
pregabalin dose
50 mg TID
| dose range 150-600 mg/day in divided doses
107
Hydroxyzine dose for GAD
25-100 mg QID
108
Hydroxyzine AEs
```
sedation
blurred vision
dry mouth
constripation
urinary retention
NOT WELL TOLERATED
```
109
Non-pharm treatment of GAD
```
stress management classes
short term counseling to improve coping skills
meditation
yoga
massage therapy
avoid caffeine, OTC stimulants
Exercise
```
110
1st line for GAD if no acute relief is needed
SNRI or SSRI
111
Drug for GAD if acute relief is needed
BZD x 4-8 weeks
112
What to use after failing a first drug in GAD
SNRI or SSRI
113
Panic disorder is characterized by
Panic attacks
114
Panic attacks peak in
10 minutes
115
for a panic attack there must be 4+ of the following symptoms
```
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
2 components of panic disorder
panic attack
| fear of having a panic attack
117
What medications are used to treat panic disorder
```
TCAs
MAOIs
SSRIs
Venlafaxine
BZDs
```
118
TCAs used for Panic disorder
Imipramine
Clomipramine
Desipramine
119
Imipramine dose for panic disorder
50 mg HS
increase by 50 mg q 3 days
150 mg HS
120
clomipramine dose for panic disorder
50 mg HS
increase by 50 mg q 3 days
150 mg HS
121
Desipramine dose for panic disorder
50 mg HS
increase by 50 mg q 3 days
150 mg HS
122
MAOI used for panic disorder
Phenelzine
123
Phenelzine dose for Panic disorder
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
SSRIs used for panic disorders
Paroxetine
Fluoxetine
Sertraline
125
Paroxetine dose for panic disorder
10 mg x 1 week
20 mg x 1 week
40 mg QD (60 if necessary)
126
Fluoxetine dose for GAD
10 mg x 1 week
20 mg x 1 week
40 mg x 1 week
60 mg QD if necessary
127
Sertraline dose for Panic disorder
25 mg x 1 week
50 mg x 1 week
100 mg QD (150-200 if necessary)
128
venlafaxine dose for panic disorder
37.5 mg QD x 1 week
75 mg QD x 1 week
150 mg QD up to 225 mg
129
Advantages of using antidepressants for panic disorder
no risk for dependence
130
disadvantages for using antidepressants for panic disorder
takes 4 weeks to effect
not PRN
d/c syndrome
sexual dysfunction
131
BZDs used for panic disorder
Alprazolam
| Clonazepam
132
Alprazolam dose for panic disorder
0,5 mg QID increase to 4-12 mg /day
133
dose of Alprazolam XR for panic disorder
0.5 mg QD
increase 0.5 mg q 3-4 days to
1-10 mg QD
134
dose of clonazepam for panic disorder
0.5 mg BID up to 3 mg BID
135
advantages of using BZDs for panic disorder
work rapidly
| PRN
136
disadvantages of using BZDs for panic disorder
Risk of abuse/dependence
137
Length of treatment for panic disorder
panic free + 12 months
138
non-pharm treatments for panic disorder
cognitive behavior therapy
| exercise
139
drug if acute relief is needed for panic disorder
BZD x 2-4 weeks + SSRI/Venlafaxine
140
1st line agents for panic disorder
SSRi or venlafaxine
141
drug given after failing one drug for panic disorder
another SSRI or venlafaxine
142
social phobia is characterized by
intense irrational fear of scrutiny or evaluation by others in social situations due to anticipation of humiliation or being made feel ridiculous
143
Age of onset of social anxiety disorder
grade school
144
Drugs for social anxiety disorder
```
MAOI
SSRI
SNRI
Beta blockers
BZDs
gabapentin
pregabalin
tramadol
```
145
MAOI used for social anxiety disorder
Phenelzine
146
Phenelzine dose for social anxiety disorder
15 mg AM x 3 days
| 45-90 mg /day in divided doses
147
SSRIs used for social anxiety disorder
paroxetine
sertraline
fluvoxamine CR
148
paroxetine dose in social anxiety disorder
30-50 mg /day
149
sertraline dose in social anxiety disorder
100-200 mg /day
150
fluvoxamine CR dose in social anxiety disorder
100-300 mg /day
151
SNRI used for social anxiety disorder
venlafaxine
152
venlafaxine dose for social anxiety disorder
37.5 mg QD
| dose range 75-225 mg /day
153
how long is an adequate trial in social anxiety disorder
12 weeks
154
which beta blockers are used for social anxiety disorder
propranolol
| atenolol
155
propranolol dose in social anxiety disorder
10-30 mg QD
156
beta blockers help with what in social anxiety disorder
symptoms (HR, tremor, blushing)
| NOT PSYCH
157
atenolol dose in social anxiety disorder
50-100 mg QD
158
BZD used in social anxiety disorder
Clonazepam
159
clonazepam dose in social anxiety disorder
0.5 mg BID
| dose range 1-4 mg/day
160
gabapentin dose for social anxiety disorder
300 mg BID
| dose range 900-3600 mg/day in divided doses
161
Pregabalin dose in social anxiety disorder
100 mg TID up to 600 mg / day
162
Buspar dose for social anxiety disorder
15-30 mg/day
163
1st line agents for social anxiety disorder
SSRI or venlafaxine XR
164
length of treatment for social anxiety disorder
12 months
165
5 subtypes of specific phobias
```
animal (spider, snake)
Natural environment (thunder)
blood-injection
situational (elevators, tunnels, bridges)
Other
```
166
Non-pharm treatment for specific phobia
avoid object
| systematic desenzitizaiton
168
define specific phobia
persistant fear of a circumscribed object or situation
169
define obsessions
intrusive or recurrent thought, image, or impulse that is anxiety provoking to the person and that cannot be ignored or suppressed voluntarily.
170
Define compulsions
Behavior or ritual that is performed in a repetitive or stereotypic way which is designed to reduce anxiety or prevent a future event.
171
treatment options for OCD
```
clomipramine
fluoxetine
fluvoxamine
paroxetine
sertraline
```
172
clomipramine brand name
anafranil
173
clomipramine dose for OCD
25 mg HS -> 100 mg daily
| max 250 mg/day
174
Fluoxetine dose for OCD
20 mg/day -> 60-120 mg/day
175
Fluvoxamine dose for OCD
50 mg hs increase by 50 mg every 4-7 days to max 300 mg/day in 2 divided doses
176
Paroxetine dose for OCD
10-20 mg/day increased by 10 mg QW up to 50mg/day
177
Sertraline dose for OCD
25-50 mg/day increased by 50 mg QW or QOW up to 200mg/day
178
nonpharm treatment for OCD
behavioral modificiation
| Cognitive behavior therapy
179
Define PTSD
characteristic symptoms after exposure to 1+ traumatic events
180
Nonpharm treatment for PTSD
CBT - Treatment of choice
| Eye movement Desensitization and Reprocessing
181
Pharm treatments for PTSD
```
TCAs
MAOIs
SSRIs
antidepressants
Anxiolytics
Adrenergic inhibitors
```
182
TCAs used for PTSD
imipramine
| amitriptyline
183
imipramine dose for PTSD
50-300 mg/day
184
amitriptyline dose for PTSD
50-300 mg/day
185
MAOIs used for PTSD
Phenelzine
186
Phenelzine dose for PTSD
15-90 mg/day
187
SSRIs used for PTSD
```
citalopram
fluvoxamine
fluoxetine
Paroxetine
Sertraline
```
188
citalopram dose for PTSD
20-60 mg/day
189
fluvoxamine dose for PTSD
100-250 mg/day
190
Fluoxetine dose for PTSD
20-80 mg/day
191
Paroxetine dose for PTSD
20 mg/day
192
Sertraline dose for PTSD
25 mg QD x 1 week, then 50 mg qd
| range 50-200 mg/day
193
other antidepressants used for PTSD
```
bupropion
mirtazepine
nefazodone
trazodone
venlafaxine
```
194
bupropion dose for PTSD
200-450 mg/day
195
mirtazepine dose for PTSD
15-45 mg/day
196
nefazodone dose for PTSD
200-600 mg/day
197
Trazodone dose for PTSD
50-400 mg/day
198
Venlafaxine dose for PTSD
75-225 mg/day
199
Anxiolytic agents for PTSD
buspirone
alprazolam
clonazepam
200
buspirone dose for PTSD
15-60 mg/day
201
Alprazolam dose for PTSD
0.25 - 6 mg/day
202
Clonazepam dose for PTSD
0.5 - 4 mg/day
203
Adrenergic inhibitors used for PTSD
clonidine
guanfacine
prazosin
propranolol
204
clonidine dose for PTSD
0.2-6 mg/day
205
guanfacine dose for PTSD
0.5-3mg HS
206
prazosin dose for PTSD
2-10 mg/day
207
propranolol dose for PTSD
40-160mg/day in divided doses
208
1st line treatment for PTSD
SSRI
209
length of treatment for PTSD
12 months.
