Anxiety, OCD and PTSD Drugs

Question 1

What do benzos do?

Answer 1

Interact with GABA-A receptor

Question 2

How do you make BZD better absorbed and quicker onset?

Answer 2

increase lipid solubility

Question 3

What are drug interaction for BZD?

Answer 3

Alcohol
CNS depressants
Cytochrome inhibitors
Antihistamines

Question 4

What are short half life benxos?

Answer 4

Alprazolam
Clonazepam
Lorazepam
Midazolam 
Oxazepam
Temazepam

Question 5

What are longer half life BZD?

Answer 5

Chlordiazepoxide
Clorazepate
Diazepam

Question 6

What are the adverse effects of benzo?

Answer 6

Drowsiness
Fatigue
Ataxia
Anticholinergic effects 
Memory impairment
Peripheral vasodilation (possible decrease in BP)
Hostility
Withdrawal syndrome
Addiction

Question 7

What are the cognitive effects of BZD?

Answer 7

Anterograde amnesia – desirable in some cases
Impair episodic memory
Impair implicit memory
Loss of inhibition
Delirium

Question 8

What is a 5-HT partial agoinst?

Answer 8

Buspirone (Buspar)

Question 9

How is buspar dosed?

Answer 9

BID/TID

Question 10

What are the adverse effects of buspirone?

Answer 10

Nausea
Dizziness
Headache

Question 11

What does buspirone cause when given with MAOI?

Answer 11

increase BP

Question 12

What is buspirone metabolized by?

Answer 12

CYP3A4

Question 13

What do you see used in kids for anxiety?

Answer 13

Hydroxyzine (Vistaril, Atarax

Question 14

What is used for acute attacks in panic disorder or agoraphobia?

Answer 14

BZD

Question 15

What is used for chronic panic disorder and agoraphobia?

Answer 15

SSRI, venlafaxine

Question 16

What is used for acute phase of panic disorder and agoraphobia?

Answer 16

BZD scheduled x 4 weeks
SSRI, venlafaxine at ¼ to ½ depression dose for 12 weeks
High doses increase anxiety symptoms

Question 17

What is the duration of therapy for panic disorder and agoraphobia?

Answer 17

12-24 months then slowly taper off over 4-6 mo

Question 18

What is used for generalized anxiety?

Answer 18

SSRI, SNRI, Pregabalin, Buspirone, Hydroxyzine, BZD last line

Question 19

What are the SSRIs?

Answer 19

fluoxetine, escitalopram may be better at achieving remission

Question 20

What are the SNRI?

Answer 20

duloxetine may produce best response

Question 21

What is used for social anxiety disorder?

Answer 21

SSRIs Doses similar to antidepressant doses
Venlafaxine – no benefit over 75mg/day
Phenelzine (MAOI) if other therapies fail
No BZDs or TCAs – not effective
May take 12 weeks to see full effect

Question 22

What do you do for phobias?

Answer 22

NO DRUGS, maybe BZD if flying

Question 23

What is used for OCD?

Answer 23

SSRI
fluoxetine, fluvoxamine, paroxetine, sertraline
Clomipramine

Question 24

What is clomipramine?

Answer 24

Strong serotonin reuptake inhibition and active metabolite that is a NE reuptake inhibitor

Question 25

What is the treatment for OCD?

Answer 25

8-12 weeks before determining treatment failure

Question 26

What is used for PTSD?

Answer 26

SSRI- fluoxetine, sertraline, paroxetine
Venlafaxine
NO BUPROPION - DOESNT WORK

Question 27

How long does it take to see results in PTSD?

Answer 27

8-12 wk, some never fully respond

Question 28

What is the treatment timeline for PTSD?

Answer 28

12-24 mo or longer

Question 29

What is not indicated for PTSD?

Answer 29

prophylatic meds

Question 30

When do you treat PTSD?

Answer 30

3-4 wk after event if no improvement

Question 31

What could interrupt recovery for PTSD?

Answer 31

immediate tx with BZD

Question 32

What BZD do not go through cytochrome?

Answer 32

LOTS

lorazepam, oxazepam, temazepam