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Anxiety Pharm Flashcards

1
Q

What are some S/S of someone diagnosised with anxiety?

A

Worry, feeling of treat, tachycardia, SOB, CP, pacing, impairment in daily function

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2
Q

What symptoms are more anxiety and not depression?

A

Depression, anhedonia, weight changes, thoughts of death

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3
Q

Is anxiety tend towards episodic or chronic

A

More chronic

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4
Q

If a new medical diagnosis causes someone anxiety what should do about the diagnosis?

A

The anxiety often subsides as the medical illness stabiles if it persist, assess for a new diagnosis

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5
Q

What CV issues can cause the feeling of anxiety?

A

Angina, arrhythmias, MI

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6
Q

What Endo issues provoke anxiety?

A

Hyperthyroidism, and hypoglycemia

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7
Q

What Neuro issues can provoke anxiety?

A

Migraines, seizures, poor pain control

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8
Q

What resp. Issues can provoke anxiety?

A

Asthma, COPD

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9
Q

What antidepressants cause anxiety?

A

SSRI, SNRI, bupropion

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10
Q

What are the 4 main neurotransmitters involved in anxiety?

A

NE

5-HT

GABA

Glutamate

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11
Q

What are the 6 types of anxiety disorders?

A

GAD

PD

SAD

Specific Phobia

OCD

PTSD

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12
Q

GAD - is excessive anxiety or worry for how long with three of the following symptoms

A

6 month

Poor concentration or mind going blank
Restlessness
Fatigue
Muscle tension
Sleep disturbance
Irritability

Impairment from the symptoms and not from something else

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13
Q

What is the scale for diagnosing anxiety?

A

GAD-7

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14
Q

Panic disorders - spontaneous?

What is the persistent concern a person with a panic disorder has

What modification is part of the attack?

A

They are spontaneous attacks and not always triggered

There is a persistent concern about another one

Change in behavior related to the attack

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15
Q

What is the difference between a panic attack and a panic disorder?

A

A panic disorder is the constant feeling that you will have another panic attack

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16
Q

What is social anxiety?

A

The intense, irrational, and persistent fear of being negatively evaluated or scrutinized in public settings

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17
Q

What works best for phobias, behavioral or pharm?

A

Behavioral

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18
Q

With OCD what does compulsion mean?

A

Repetitive behavior or mental act performed in response to an obsession or to alleviate anxiety associate with obessessions

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19
Q

What is the three presentations of PTSD

A
  1. Avoidance
  2. Hyperarousal: on edge, startled, irritability and insomnia
  3. Re-experience symptoms
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20
Q

What is the first line treatment of anxiety?

A

Antidepressants

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21
Q

The side effect of anxiety with antidepressant meds tapers off after how long? Should scheduled benzos or scheduled Gabapentin and pregabalin be prescribed and why?

A

8-12 weeeks

GABA and pregaba: They kick in quicker than antidepressants and you don’t get the benzo rebound when you stop them after the antidepressants kick in.

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22
Q

What is the best med for social anxiety PRN?

A

Propranolol

23
Q

What is the three drugs used for acute anxiety?

A

Hydroxyzine (Atarax, vistaril)

Propranolol

Gabapentin/pregabalin

24
Q

What is the last part of the name of most of benzo’s

A
  • zepam

- zolam

25
What three benzo’s have a fast onset and an fast duration of action? And thus the highest rate of abuse? Also are lipophilic?
Diazepam Clorazepate Alprazolam “All chloride will make you die”
26
What two benzo’s are less lipophilic, slower onset and longer duration of action? Also can be given IM?
Lorazepam Oxazepam
27
What three meds are less prone to interactions and safer for elderly and those with hepatic dysfunction?
Lorazepam Oxazepam Temazepam “LOT”
28
Which one of the benzo’s are prodrugs
Clorazepate
29
How long if any, should you limit scheduled benzo’s
No more than 2-4 weeks
30
What are the 4 main drug/substance interactions with Benzo’s
Alcohol, narcotics, antipsychotics, antihistamines
31
Benzo’s can be cyp3A4 inhibitors. What antidepressant should you avoid?
Fluvoxamine - this treats OCD
32
If you are on fluvoxamine what benzo’s don’t interact?
Clorazepate Lorazepam Oxazepam Temazepam Take “CLOT” if you are on fluvoxamine
33
BB warning: what other drug do you not take with Benzo’s
Opioids
34
After how long can someone be taking benzo’s and then be tapered and not abruptly stopped
2 weeks
35
How do you taper benzo’s
Decrease by 25% Until 50% of dose reached Then reduce by 12.5% every 4 to 7 days
36
If you took benzo’s for more than 8 weeks how long do you taper
2-3 weeks
37
If you took benzo’s for 6-12 months, how long do you taper
4-8 weeks
38
If you took benzo’s for greater than a year how long do you taper
2-6 month
39
What part of the pregnancy do you avoid benzo’s
1st and 3rd
40
If the pt has to take a benzo in the 3rd trimester, what benzo should you avoid
Diazepam - multiple active metabolites with long half life Use lorazepam
41
How long does Anxiolytic’s take to have effect
4-12 Weeks
42
Why is antidepressants used for anxiety?
Because they target the underlying cause. Which involves the dysregulation of serotonin and NE They also don’t cause addiction issues
43
Which antidepressant is effective for all 5 anxiety disorders
SSRI
44
Is the anti-anxiety effect that antidepressants have a class effect?
Yes
45
FOR DOSING - What can you do to alleviate the side effect of anxiety with antidepressants
Start very low and increase every few days
46
What is the only indication for Buspirone? And is it first or second line?
GAD, second line
47
Can you use Buspirone with fluvoxamine?
No, Metabolized by CYP3A4
48
Can you use Buspirone as a PRN
No, it must be scheduled 2-3 times a day
49
What med is a second line agent for GAD
Hydroxyzine (atarax, vistaril)
50
Can Hydroxyzine be used PRN
YEs
51
What is the one pt to not prescribe Gabapentin/Pregabalin?
Renally impaired
52
What is the downside of the half life of Gabapentin?
Short half life. They need to be dosed several times a day
53
Even though there is not abuse potential how long should you taper GABA/pregaba if you stop the med?
Over a week, can cause rebound anxiety

Pharm Seizures (8 decks)

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