Anxiolytic

Question 1

What are the 4 essentials of diagnosis for anxiety?

Answer 1

Overt anxiety or an overt manifestation of a coping mechanism (such as a phobia) or both

Not limited to an adjustment disorder

Somatic symptoms referable to the autonomic nervous system or to a specific organ system (eg, dyspnea, palpitations, paresthesias)

Not a result of physical disorders, psychiatric conditions (eg, schizophrenia), or drug abuse (eg, cocaine)

Question 2

What are common CV medical illnesses associated with anxiety sx?

Answer 2

angina

arrhythmias

cardiomyopathy

congestive heart failure

hypertension

ischemic heart disease

mitral valve prolapse

myocardial infarction

Question 3

What are common endocrine & metabolic illnesses associated with anxiety sx?

Answer 3

Cushing disease

diabetes

hyperparathyroidism

hyperthyroidism

hypothyroidism

hypoglycemia

hyponatremia

hyperkalemia

pheochromocytoma

vitamin B12 or folate deficiencies

Question 4

What are common GI illnesses associated with anxiety sx?

Answer 4

Crohn disease

irritable bowel syndrome

ulcerative colitis

peptic ulcer disease

Question 5

What are common Neurological medical illnesses associated with anxiety sx?

Answer 5

Migraine

seizures

stroke

neoplasms

poor pain control

Question 6

What are common Respiratory system illnesses associated with anxiety sx?

Answer 6

Asthma, chronic obstructive pulmonary disease, pulmonary embolism, pneumonia

Question 7

What are the 5 1st line drugs for GAD

Answer 7

Duloxetine

Escitalopram

Paroxetine

Sertraline

Venlafaxine XR

Question 8

What are the 4 2nd line drugs for GAD?

Answer 8

Benzodiazepines

Buspirone

Imipramine

Pregabalin

Question 9

Alternative drugs for GAD

Answer 9

Hydroxyzine

Quetiapine

Question 10

1st line drugs for panic disorder?

Answer 10

SSRIs

Venlafaxine XR

Question 11

2nd line for panic disorder?

Answer 11

Alprazolam

Citalopram

Clomipramine

Clonazepam

Imipramine

Question 12

Alternative drugs for panic disorder?

Answer 12

Phenelzine

Question 13

6 1st line drugs for social anxiety d/o?

Answer 13

Social anxiety disorder

Escitalopram

Fluvoxamine CR

Paroxetine

Sertraline

Venlafaxine XR

Question 14

2nd line drugs for social anxiety disorder?

Answer 14

Clonazepam

Citalopram

Question 15

Alternative drugs for social anxiety disorder?

Answer 15

Gabapentin

Phenelzine

Pregabalin

Question 16

partial agonist at 5-HT receptors and possibly D2 receptors

interacts with the 5-HT1A subclass of brain serotonin receptors as a partial agonist

minimal CNS depressant effects (it does not affect driving skills)

no anticonvulsant or muscle relaxant properties

MOA of which drugs?

Answer 16

selective anxiolytic

Question 17

What are the PK of anxiolytics?

Answer 17

slow onset of action (>1 week)

oral activity

forms active metabolite

interactions with CYP3A4 inducers and inhibitors

short half-life

Question 18

Indications for using Buspirone?

Answer 18

used in GAD

less effective in panic disorders

Question 19

Adverse effects of Buspirone

Answer 19

GI distress, tachycardia

paresthesia

Question 20

Dependency of Buspirone

Answer 20

tolerance development is minimal with chronic use

little rebound anxiety or withdrawal symptoms on discontinuance

Question 21

Is Buspirone safe in pregnancy?

Answer 21

Yes