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7453 Neuro Test 4 > Anxiety Pharmacotherapy > Flashcards

Anxiety Pharmacotherapy Flashcards

1
Q

GAD 7 Item Questionare:

Mild score?

A

5-9

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2
Q

GAD 7 Item Questionare:

Moderate score?

A

10-14

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3
Q

GAD 7 Item Questionare:

Severe score?

A

15-21

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4
Q

Most effective and safe drug class for RAPID relief of anxiety Sx?

A

benzos

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5
Q

5 first line drugs for GAD?

DEPSV

A 
D - duloxetine
E - escitalopram
P - paroxetine
S - sertraline
V - venlafaxine XR
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6
Q

First line drug class for panic disorder?

A

SSRIs

also venlafaxine XR

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7
Q

5 first line drugs for social anxiety disorder?

EFPSV

A 
E - escitalopram
F - fluvoxamine CR
P - paroxetine
S - sertraline
V - venlafaxine XR
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8
Q

What atypical antipsychotic is used for GAD?

A

quetiapine 150mg

quetiapine 150mg = paroxetine 20mg/day

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9
Q

What is used in Europe as a first line agent for GAD, but is off-label at best in the USA?

A

pregabalin

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10
Q

What benzo is FDA approved for panic disorder with or without agoraphobia.

A

alprazolam

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11
Q

IM administration of which 2 benzos should be avoided?

A
  • diazepam
  • chlordiazepoxide

erratic absorption and painful

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12
Q

Which 2 benzos are glucuronidated?

A
  • lorazepam

- oxazepam

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13
Q

Which benzo undergoes nitroreduction?

A

clonazepam

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14
Q

__ is a prodrug converted to desmethyldiazepam in the GI tract under acidic pH.

A

clorazepate

watch out for antacid use!!

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15
Q

___ is a physiologic occurrence that manifests when the drug is abruptly d/c.

A

dependence

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16
Q

Time to onset of withdrawal Sx for short acting benzos?

A

24-48hrs

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17
Q

Time to onset of withdrawal Sx for long-acting benzos?

A

3-8 days

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18
Q

Can buspirone be used in pts with substance abuse history?

A

yes

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19
Q

How long until max benefit of buspirone?

A

4-6 weeks

increase dose by 5mg every 2-3 days

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20
Q

Which SSRI is not a preferred agent for pregnant pts?

A

paroxetine

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21
Q

What class of anxiety drugs are associated with cleft lip and palate in babies?

A

benzos

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22
Q

Benzos should be avoided in which trimester?

A

first

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23
Q

Benzo use in which trimester can cause sedation, withdrawal, and floppy baby syndrome?

A

third

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24
Q

Which two benzos can cause neonatal withdrawal Sx?

A
  • lorazepam

- alprazolam

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25
Pts with Hx of substance/alcohol abuse should not use benzos. a. true b. false
a. true
26
Which TCA can work in 4 weeks for panic disorder attacks, and has max improvement in 8-12 weeks for anti phobic?
imipramine
27
How long is panic disorder acute phase Tx?
1-3 months therapy altered if no response in 6-8 weeks
28
How long is panic disorder maintenance Tx?
12-24 months drug d/c over 4-6 months
29
How long is the continuation phase of social anxiety disorder?
3-6 months
30
Are TCAs effective for social anxiety disorder?
no SSRIs and SNRIs equally effective
31
Which 2 SSRIs are FDA approved for panic disorder?
- sertraline | - paroxetine
32
Which 2 benzos are FDA approved for panic disorder?
- clonazepam | - alprazolam
33
What drug class is last line for children with social anxiety disorder?
benzos
34
Is gabapentin effective for social anxiety disorder?
yes
35
What is the minimum amount of time needed for treatment with a SSRI for a pt with panic disorder who responds to a SSRI agent?
minimum of 12 months | can be up to 24 months
36
What two SSRI agents are FDA approved for acute PTSD?
- sertraline | - paroxetine
37
What dose-dependent AE is associated with clomipramine?
seizures
38
Which agent would you recommend for a child age 10 yrs for OCD Tx, fluvoxamine or clomipramine?
fluvoxamine
39
2 goals of PTSD therapy?
- decrease core Sx | - improve QOL
40
Which SSRI is FDA approved for long term PTSD Tx?
sertraline
41
Are benzos effective for treating PTSD?
no
42
Which SSRI shows no dose-dependent improvement of PTSD?
paroxetine
43
Which class of meds decreases numbing PTSD symptoms?
SSRIs
44
What medication is effective for PTSD in global ratings with doses of 45mg/day?
mirtazapine
45
Which med is effective for PTSD avoidance/numbness and hyperarousal?
venlafaxine
46
What alpha 1 adrenergic antagonist is useful in some PTSD pts to decrease nightmares and sleep disturbance?
prazosin
47
Sertraline should be increased at what rate for PTSD?
50mg/week
48
Paroxetine should be increased at what rate for PTSD?
10mg/week
49
Dosing/administration of SSRIs for PTSD when slow response wanted?
start after 3-4 weeks at low doses 8-12 weeks needed to assess response
50
What drug class may be helpful for PTSD explosiveness, intrusive thoughts, aggression, and flashbacks?
atypical antipsychotics
51
Is risperidone effective for add on therapy in PTSD?
total effects questionable
52
How often are PTSD pts seen?
weekly for 1 month, then every other week for the second month months 3-6: see monthly months 6-12: see every other month
53
___ % reduction of Sx is considered remission for PTSD.
70
54
SSRIs should be used for __ to __ weeks for PTSD initially.
8, 12 4-6 weeks at max dose
55
5 FDA approved drugs for OCD?
- clomipramine - fluvoxamine - fluoxetine - paroxetine - sertraline
56
What rating scale is used by clinicians for OCD?
YBOCS
57
If one SSRI is ineffective for OCD, another should not be attempted. a. true b. false
b. false
58
OCD Tx resistance is failure to decrease __ % from baseline YBOCS scores.
25
59
Which SSRI PK is not altered in renal failure pts?
sertraline
60
Do OCD pts with renal failure need clomipramine dosage adjustments?
no be careful dosing anyway
61
Which OCD SSRI has increased Cpss in renally impaired pts?
paroxetine
62
What should be used first for OCD in pregnancy?
CBT alone
63
What SSRI is safest for OCD in pregnancy?
fluoxetine avoid clomipramine
64
What is an adequate Tx period for OCD?
10-12 weeks
65
What should be tried next if CBT or SSRI for OCD do not provide adequate response?
combo therapy with CBT + SSRI should be tried before augmentation with another agent
66
What is max dose of citalopram for OCD?
40mg to prevent QTc prolongation
67
What should pts over 40yrs old get before clomipramine Tx?
ECG
68
Why should WBC with differential be gotten immediately if fever/sore throat with clomipramine?
possible agranulocytosis
69
How long for tolerance to clomipramine AEs?
2 weeks
70
Do TCAs or clomipramine cause more seizures?
clomipramine OCD Tx
71
Is venlafaxine FDA approved for OCD?
no can be used, but not approved
72
How long should pt be at max dose for OCD Tx before switching?
8-13 weeks therapy for 1-2 years
73
How should drugs be tapered for OCD?
10-25% every 1-2 months
74
How often should visits occur for OCD?
monthly for 3-6 months
75
Which age group more commonly has trichotillomania?
> 18yrs
76
Trichotillomania: What type is minimal thinning that can be camouflaged with hair styling techniques?
type 1
77
Trichotillomania: Which type is characterized by decreased volume and noticeable widening of the midline part?
type 2
78
Trichotillomania: Which type is characterized by diffuse thinking, with see through appearance on top of scalp?
type 3
79
Most pts with trichotillomania are unemployed females > 18yrs old. a. true b. false
b. false employed, > 18yr old female
80
What is the most common age range for onset of trichotillomania?
6-12yrs old

7453 Neuro Test 4 (9 decks)

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