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Pharm Seizures > Anxiety Pharm > Flashcards

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
Q

What three benzo’s have a fast onset and an fast duration of action? And thus the highest rate of abuse? Also are lipophilic?

A

Diazepam

Clorazepate

Alprazolam

“All chloride will make you die”

26
Q

What two benzo’s are less lipophilic, slower onset and longer duration of action? Also can be given IM?

A

Lorazepam

Oxazepam

27
Q

What three meds are less prone to interactions and safer for elderly and those with hepatic dysfunction?

A

Lorazepam

Oxazepam

Temazepam

“LOT”

28
Q

Which one of the benzo’s are prodrugs

A

Clorazepate

29
Q

How long if any, should you limit scheduled benzo’s

A

No more than 2-4 weeks

30
Q

What are the 4 main drug/substance interactions with Benzo’s

A

Alcohol, narcotics, antipsychotics, antihistamines

31
Q

Benzo’s can be cyp3A4 inhibitors. What antidepressant should you avoid?

A

Fluvoxamine - this treats OCD

32
Q

If you are on fluvoxamine what benzo’s don’t interact?

A

Clorazepate

Lorazepam

Oxazepam

Temazepam

Take “CLOT” if you are on fluvoxamine

33
Q

BB warning: what other drug do you not take with Benzo’s

A

Opioids

34
Q

After how long can someone be taking benzo’s and then be tapered and not abruptly stopped

A

2 weeks

35
Q

How do you taper benzo’s

A

Decrease by 25%

Until 50% of dose reached

Then reduce by 12.5% every 4 to 7 days

36
Q

If you took benzo’s for more than 8 weeks how long do you taper

A

2-3 weeks

37
Q

If you took benzo’s for 6-12 months, how long do you taper

A

4-8 weeks

38
Q

If you took benzo’s for greater than a year how long do you taper

A

2-6 month

39
Q

What part of the pregnancy do you avoid benzo’s

A

1st and 3rd

40
Q

If the pt has to take a benzo in the 3rd trimester, what benzo should you avoid

A

Diazepam - multiple active metabolites with long half life

Use lorazepam

41
Q

How long does Anxiolytic’s take to have effect

A

4-12 Weeks

42
Q

Why is antidepressants used for anxiety?

A

Because they target the underlying cause. Which involves the dysregulation of serotonin and NE

They also don’t cause addiction issues

43
Q

Which antidepressant is effective for all 5 anxiety disorders

A

SSRI

44
Q

Is the anti-anxiety effect that antidepressants have a class effect?

A

Yes

45
Q

FOR DOSING - What can you do to alleviate the side effect of anxiety with antidepressants

A

Start very low and increase every few days

46
Q

What is the only indication for Buspirone? And is it first or second line?

A

GAD, second line

47
Q

Can you use Buspirone with fluvoxamine?

A

No, Metabolized by CYP3A4

48
Q

Can you use Buspirone as a PRN

A

No, it must be scheduled 2-3 times a day

49
Q

What med is a second line agent for GAD

A

Hydroxyzine (atarax, vistaril)

50
Q

Can Hydroxyzine be used PRN

A

YEs

51
Q

What is the one pt to not prescribe Gabapentin/Pregabalin?

A

Renally impaired

52
Q

What is the downside of the half life of Gabapentin?

A

Short half life. They need to be dosed several times a day

53
Q

Even though there is not abuse potential how long should you taper GABA/pregaba if you stop the med?

A

Over a week, can cause rebound anxiety

Pharm Seizures (8 decks)

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