Anxiety disorders Flashcards
Drugs that can incr anxiety
Albuterol (used incorrectly or too much) antipsychotics Bupropion Caffeine (high doses) sudafed Levothyroxine stimulants steroids illict drugs
Comorbidities that can increase anxiety
hyperthyroidism
1st line treatment for anxiety disorders
certain SSRIs and SNRIs
Which SSRI/SNRI are approved in anxiety disorders? 96 total)
Escitalopram Fluoxetine Paroxetine Sertraline Duloxetine Venlafaxine XR
Doses of SSRI/SNRIs used
usually have the initial dose used for depression
Buspar
buspirone
Buspar use
adjunctively with antidepressants (2nd-line)
Buspar MOA
unknown
has affinity for 5HT1a and 5HT2
Buspar side effects
Nausea
dizziness
drowsiness
HA
Buspar clinical pearls
do not use w/ MAO iinhibitors or w/in 14 days of use takes 2-4 weeks to be effective titrate by 5mg/day every 2-3 days Max 30 mg BID take with or w/o food, but be consistent
Buspar metabolism
major CYP3A4 substrate
Other 2nd line options for anxiety
TCA’s (not FDA approved)
Hydroxyzine (sedating, doesn’t treat underlying condition)
Lyrica: used for pts w/ nerve pain + anxiety
Indication for beta blockers (propranolol) in anxiety disorders
Use for performance anxiety
take 10-40 mg of propranolol 1 hr prior to event
BZD MOA
potentiate GABA (inhibitory NT)
anxiolytic
anticonvulsant
sedative
some muscle relaxant properties
recommended duration of BZD therapy
1-2 weeks then d/c
HA, GOOD ONE
BZD boxed warnings
use with opioids can result in sedation, respiratory depression, coma, death
BZD contraindications
acute narrow-angle glaucoma sleep apnea severe resp disease severe liver disease (clonazepam, diazepam) myasthenia gravis
BZD warnings
dependence and tolerance w/ long-term use; must taper slowly when d/c amnesia cns dpression potential for abuse Pregnancy - birth defects
BD side effects
somnolence dizziness weakness ataxia lightheadedness
diazepam clinical pearls
lipophilic
fast onset
long t1/2
alprazolam clinical pearls
fast onset
high abuse potential
contraindicated with strong CYP3a4 inhibitors (ketoconazole, etc)
BZDs used for alcohol withdrawal symptoms
lorazepam
diazepam
chlordiazepoxide
BZDs safer in elderly and pts with hepatic impairment
lorazepam
oxazepam
temazepam
LOT
What duration requires tapering of BZDs?
more than 10 days
