Anxiety, OCD, and PTSD

Question 1

What are the goals of pharmacotherapy in treating anxiety?

Answer 1

Control symptoms

• Rapid onset of action
• No potential for abuse, dependence, or withdrawal
• Efficacy on comorbidity

Prevent Relapse

Question 2

What are the first line agents to be used for performance type of anxiety?

Answer 2

Propranolol

Atenolol

Question 3

How do beta blockers help reduce anxiety?

Answer 3

Decrease HR

Reduce tremors

Question 4

What conditions are contraindications for beta-blockers?

Answer 4

Bradycardia or Heart block
Asthma or COPD
Angle-closure glaucoma
Diabetics

Question 5

What BZDs are used to treat anxiety?

Answer 5

Alprazolam
Chlordiazepoxide
Clonazepam
Clorazepate
Diazepam
Lorasepam
Oxazepam

Question 6

List BZDs from longest to shortest halft life.

Answer 6

Diazepam
Clonazepam
Temazepam
Lorazepam
Alprazolam

Question 7

In regards to eating, when should benzos be taken?

Answer 7

On an empty stomach and without antacids.

Question 8

Return of original symptoms.

Answer 8

Relapse

Question 9

Return of original symptoms at a greater intensity than before.

Answer 9

Rebound

Question 10

Occurrence of symptoms not previously experienced.

Answer 10

Withdrawal

Question 11

What are the signs of severe BSD withdrawal?

Answer 11

Hallucinations
Delirium
Seizures

Question 12

Withdrawal symptoms on discontinuation of long-term use.

Answer 12

Dependence

Question 13

Compulsive use of a substance depsite negative consequences.

Answer 13

Addiction

Question 14

What factors increase the risk of BZD dependence?

Answer 14

Longer-term treatment
Higher dosage
Higher-potency
Shorter-half-life

Question 15

What type of anxiety disorders are SSRIs indicated for?

Answer 15

Panic anxiety
OCD
GAD
PTSD
Social anxiety

Question 16

Which SNRI can be used to treat GAD, social anxiety disorder, panic disorder, and PTSD?

Answer 16

Venlafaxine

Question 17

Which TCAs were used to treat PD/PDA and GAD?

Answer 17

Imipramine
Desipramine
Doxepin

Question 18

Which TCA is still widely used for treating OCD?

Answer 18

Clomipramine

Question 19

How can you avoid the “jitteriness” when starting someone on a TCA?

Answer 19

Start low and go slow

Question 20

What anxiety disorders can MAOI be used to treat?

Answer 20

Panic disorder

Social anxiety disorder

Question 21

What are the two most commonly used MAOIs?

Answer 21

Phenelzine

Tranylcypromine

Question 22

What antihistamine is commonly used to treat anxiety disorders?

Answer 22

Hydroxyzine

Question 23

What are the major side effects of hydroxyzine?

Answer 23

Drowsiness

Dry mouth

Question 24

What is the benefit of using hydroxyzine?

Answer 24

No risk of dependance

Question 25

What other medications should be avoided in conjunction with hydroxyzine?

Answer 25

Alcohol Narcotics CNS depressants TCAs

Question 26

What is the MOA of buspirone?

Answer 26

Partial agonist of 5-HT1A

Question 27

What is the indication for buspirone?

Answer 27

GAD

Question 28

How long might it take buspirone to work?

Answer 28

4-6 weeks

Question 29

In what way are BZDs superior to treating anxiety disorders than buspirone?

Answer 29

More rapid response | Slightly more effective at treating somatic symptoms

Question 30

What anticonvulsants are used to treat anxiety disorders?

Answer 30

Gabapentin Divalproex Pregabalin

Question 31

What is the main anxiety disorder gabapentin can be used to treat?

Answer 31

Social anxiety

Question 32

What is the benefit of using gabapentin over other drugs for anxiety?

Answer 32

Few DDI | Less potential for abuse

Question 33

What anxiety disorders can be treated with divalproex?

Answer 33

Resistant panic disorder

Question 34

What anxiety disorders can pregabalin be used to treat?

Answer 34

GAD | Social anxiety disorder

Question 35

What is the main benefit of using pregabaline over other anticonvulsants?

Answer 35

Well tolerated in patients with hepatic dysfunction.

Question 36

What medication has been show to help reduce nightmares, improve sleep, reduce hyperarousal, numbing, and reexperiencing?

Answer 36

Prazosin

Question 37

What other anticonvulsants have been shown to have some efficacy in treating PTSD?

Answer 37

Topiramate Lamotrigine Levetiracetam

Question 38

What aren't antipsychotics used to treat anxiety?

Answer 38

Little evidence exists to support their use at this time.

Question 39

When can atypical antipsychotics be used to treat anxiety?

Answer 39

When more established agents have been exhausted.

Question 40

What is the appropriate first step if anxiety and depression copresent?

Answer 40

Treat depression first