Anxiolytics Flashcards
1
Q
____ is an emotional state caused by the perception of real or potential danger that threatens the security of the individual
A
Anxiety
2
Q
What are some symptoms of anxiety?
A
-Heart pounds
-Butterflies in stomach
-Shaking
-Trembling
-Sweating
3
Q
An ___ ___ connotes significant distress and dysfunction due to the anxiety
A
Anxiety disorder
4
Q
Usually, the anxiety response is usually reasonable with a build-in control mechanism to return to a normal ____ ____
A
Physiological state
5
Q
What are some examples of anxiety disorders?
A
-General anxiety disorder
-Panic (with or without agoraphobia)
-Phobia (social and/or specific)
-Obsessive-compulsive
-PTSD
6
Q
____ ____ disorder causes people to worry about numerous events/activities
A
Generalized anxiety
7
Q
General anxiety disorder is diagnosed if someone has ___ months of persistent symptoms
A
6
8
Q
____ disorders cause intense feelings or fear of discomfort
A
Panic
9
Q
Panic disorders cause spontaneous attacks that last ___-___ minutes
A
20-30
10
Q
____ is anxiety about being in places or situations from which escape might b difficult or embarrassing or in which help may not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms
A
Agoraphobia
11
Q
Agoraphobic fears typically involve characteristic clusters of situations that include being…
A
-Outside the home alone
-Being in a crowd or standing in a line
-Being on a bridge
-Traveling on a bus, train, or automobile,
12
Q
____% of the population has an anxiety disorder
A
25
13
Q
___ ___ are the most common anxiety disorder, with a 12-month prevalence of 8.7%
A
Specific phobias
14
Q
The one year prevalence of generalized anxiety disorder is ____%
A
3.1
15
Q
The one year prevalence of panic disorder is ____%
A
2.7
16
Q
The one year prevalence of social anxiety disorder is ___%
A
6.8
17
Q
Anxiety disorders are more common in what gender (2:1)?
A
Females
18
Q
Anxiety disorders are also more common in those with family history of ____ and ____
A
Anxiety and depression
19
Q
Anxiety disorders are commonly co-morbid with other disease states like…
A
-Major depression
-Schizophrenia
-Mood disorder
-Alcohol and drug abuse
20
Q
Anxiety disorders generally develop before age ____
A
30
21
Q
What medical diseases can cause anxiety?
A
-Anemia
-Hyperthyroidism
-Pain
-Asthma
22
Q
Knowledge of ones ____ (cancer, diabetes) can also trigger and complicate therapy for anxiety
A
Illness
23
Q
What psychiatric diseases can present with anxiety?
A
-Mood disorders
-Schizophrenia
-Delirium
24
Q
Most patients will have ____ or more psychiatric disorders within a lifetime
A
2
25
What types of drugs can induce anxiety?
-Stimulants
-CNS depressant withdrawal (Benzodiazepines)
-Antipsychotics
-SSRIs
26
Anxiety mimics symptoms of other medical conditions like...
-Palpitations
-Tachycardia
-Chest pain
-Short of breath
-Hyperventilation
27
What are examples of stimulants that might cause anxiety?
-Albuterol
-Cocaine
-Amphetamines
-Pseudoephedrine
28
What are two things in the diet that may cause anxiety?
-MSG (Chinese restaurant syndrome)
-Caffeine
29
Multiple brain structures and multiple _____ are involved in the modulation of anxiety
Neurotransmitters
30
Anxiety may be cause by neurochemical abnormalities with things like...
-Norepinephrine
-Serotonin
-GABA
-Corticotrophin-releasing factor
-Cholesystokinin
31
Genetics can play a role in development of anxiety disorders, as well as environmental factors like...
-Abusive environments
-PTSD
32
The medications we use for anxiety exert their actions on different parts of the brain and effect different ____
Neurotransmitters
33
Too much ____ release in response to stress can dampen the negative feedback over time, leading to symptoms of anxiety
Norepinephrine
34
_____ has no definitive role in anxiety, but it appears to be involved
Serotonin
35
____ is a major inhibitory neurotransmitter that regulates norepinephrine and serotonin systems; it can decrease nerve excitability
GABA
36
What are treatment goals for anxiety disorders?
-Decrease anxiety and improve adaptive functioning
-Prevent secondary medical or psychiatric disorder
-Minimize adverse effects of medication
-Prevent relapse/recurrence
37
Non-pharmacological treatments of anxiety include...
-Identifying the source of anxiety
-Assessing factors which may contribute to anxiety (diet, medications, etc)
-Behavioral modication
38
What are examples of behavioral modifications for treating anxiety?
-Cognitive behavioral therapy
-Stress/time management
-Psychotherapy
-Meditative/relaxation techniques
-Exercise
39
The primary non-pharmacological treatment for anxiety is one-on-one ____
Therapy
40
What are 4 classes of drugs that are commonly prescribed for the treatment of anxiety disorders?
-Benzodiazepines
-Buspirone (Buspar)
-Antidepressants
-Beta-blockers
41
What are two examples of Benzodiazepines?
-Ativan
-Valium
42
What are three antidepressants commonly prescribed for anxiety?
-TCAs (amitriptyline)
-SSRI (Lexapro, Paxil)
-Venlafaxine (Effexor XR)
43
What is an examples of a Beta-blocker prescribed for anxiety?
Propranolol (Inderal)
44
____ is a drug that is not approved for use in anxiety disorders
Wellbutrin
45
_____ are used adjunctively (though not FDA approved) to treat anxiety disorders (this includes Depakote, Topamax, Lamictal, and Neurontin)
Anticonvulsants
46
____ (Atarax, Vistaril) is an antihistamine/anticholinergic that causes sedation and can be used for anxiety disorders
Hydroxyzine
47
Hydroxyzine can also be used as an ____ for itching
Antipruitic
48
What are two examples of non-prescription pharmacological treatments of anxiety?
-Diphenhydramine (Benadryl) - sedative/antihistamine
-Ethanol (the oldest anxiety "remedy")
49
Benzodiazepines are widely used in the treatment of anxiety, but are also used for...
-Insomnia
-Skeletal muscle spasm and spasticity
-Alcohol withdrawal
-Certain convulsive disorders
-Preanesthetic in procedures such as endoscopy, bronchoscopy, and cardioversion
50
What are commonly used benzodiazepines in the United States?
-Chlordiazepoxide (Librium)
-Lorazepam (Ativan)
-Diazepam (Valium)
-Oxazepam (Serax)
-Alprazolam (Xanax)
-Clorazepate (Tranxene)
-Triazolam (Halcion)
51
What is the mechanism of action of benzodiazepines?
-They bind to GABA-RC and facilitate GABA binding to the receptor
-They intensify GABA-induced chloride conductance (hyperpolarization)
-Cause decreased neuronal firing (CNS depression)
52
What are some clinical considerations with benzodiazepines?
-Dose requirements vary widely among patients
-Relatively high therapeutic index
-Issues of tolerance, dependence, and withdrawal
-May want to avoid if alcohol abuse is suspected
-Use Benzodiazepines with caution in the elderly, particularly drugs with long half-lives
53
Benzodiazepines are usually well tolerated and have minimal effects on...
-Blood pressure
-Heart rate
54
Some side effects that may be caused by benzodiazepines include...
-Sedation
-Psychomotor and memory impairment
-Nightmares (rare)
55
Benzodiazepines may cause a paradoxical reaction where someone has symptoms like...
-Excitement
-Agitation
-Confusion
56
With Benzodiazepines, tolerance builds to sedation, muscle relaxant, and anticonvulsant activities but not to ____ and ___ efficacy
Anxiolytic and anti-panic
57
The risk of dependence/withdrawal with benzodiazepines is low if there is no history of _____ _____
Substance abuse
58
The risk of dependence/withdrawal with benzodiazepines is high if there is a history of ___ ___ and/or a diagnosis of a ___ ___
Alcohol abuse; personality disorder
59
Benzodiazepine withdrawal symptoms can be seen within ___-___ days from a short-acting agent or ___-___ days if using a long-acting agent
1-2; 5-10
60
What are symptoms of benzodiazepine withdrawal?
-Anxiety (rebound)
-Agitation
-Restlessness
-Fatigue
-Headache
-Sweating
-Irritability
-Delusions
-Hallucinations
-Seizures
61
If discontinuing benzodiazepines, ____ the dose down over several weeks
Taper
62
Benzodiazepine withdrawal should be minimum if the patient was on the medication for less than ___ months
6
63
Usually, a good rule of thumb is decreasing the benzodiazepine dose by ____% each week to discontinue the drug
10
64
What are examples of long-acting benzodiazepines?
-Clorazepate
-Flurazepam
-Chlordiazepoxide
-Diazepam
65
What are examples of long-acting benzodiazepines?
-Clorazopate
-Flurazepam
-Chloridiazepoxide
-Diazepam
66
What are examples of short/intermediate-acting benzodiazepines?
-Alprazolam
-Lorazopam
-Oxazepam
-Tempazepam
-Estazolam
-Triazolam
67
Alprazolam has a half-life of ___-___ hours
6-20
68
Lorazepam has a half-life of ____-____ hours
10-20
69
Oxazepam has a half-life of ___-___ hours
5-15
70
Temazepam has a half-life of ___-___ hours
10-20
71
Estazolam has a half-life of ___-___ hours
10-24
72
Triazolam has the shortest half-life of ___-___ hours
1.5-5
73
_____ is the oldest benzodiazepine and is used for alcohol withdrawal
Chlodiazepoxide (Librium)
74
_____ is widely used to treat anxiety due to the rapid onset of the effect
Diazepam (Valium)
75
Oxazepam (Serax) has a ___ absorption and ____ duration
Slow; short
76
Oxazepam (Serax) is used for...
-Elderly or patients with hepatic disease
-Alcohol withdrawal
77
____ has the most potent anti-anxiety effects
Alprazolam (Xanax)
78
____ is an example of a Benzodiazepine antagonist
Flumazenil (Romazicon)
79
Flumazenil (Romazicon) has a high ____ for benzodiazepine receptors, but lacks efficacy
Affinity
80
___-___ mg of Flumazenil (Romazicon) can be given intravenously to reverse benzodiazepine effects
0.2-0.3
81
Benzodiazepines have no effect on ____
Barbiturates
82
Buspirone (Buspar) has been approved by the FDA for use in ___ ___ ___
Generalized anxiety disorder
83
The structure and mechanism of Buspirone (Buspar) differs from ____
Benzodiazepines
84
Mechanism of action of Buspirone (Buspar):
-5-HT1A (serotonin) receptors involved in fear and anxiety
-Partial (weak) agonist of 5-HT1A (serotonin) receptors
85
The anxiolytic effect of Buspirone (Buspar) takes ____, versus days with benzodiazepines
Weeks
86
Buspirone also has some _____ effect
Antidepressant
87
Buspar does not work, however, for ____ disorder
Panic
88
Buspirone (Buspar) is non-____ and also non-addicting
Sedating
89
Buspirone (Buspar) is not effective as a _____
Hypnotic
90
Buspirone (Buspar) has no _____ activity
Anticonvulsant
91
What is the standard initial dose of Buspirone (Buspar)?
-5-7.5 mg orally two times per day
-Titrate (increase) 5 mg every 2-3 days
92
What is the average dose range of Buspirone?
-20-30 mg/day (usually split into two to three doses per day)
-Max of 60 mg/day
93
Buspirone is effective within ___-___ weeks, with maximum relief at 6 weeks (2-4 weeks for full effect)
1-2
94
Buspirone is not for ____ use, but we can supplement benzodiazepines if needed (works very well when benzodiazepines are prescribed on an "as needed basis" for anxiety
PRN
95
What are some disadvantages of Buspirone (Buspar)?
-No anticonvulsant or muscle relaxant properties
-No immediate effect
-Not useful on an "as needed" basis
-Multiple dosing: two to three times per day
96
What are some advantages of Buspirone (Buspar)?
-Low abuse/addiction potential
-Less sedation, motor impairment
-No additive effects with alcohol
97
What is the mechanism of action for Venlafaxine (Effexor XR)?
-Potent inhibitor of serotonin and norepinephrine reuptake
98
Only the ____ form of Venlafaxine is approved for generalized anxiety disorder
XR
99
What are the doses of Venlafaxine (Effexor XR) capsules?
-37.5 mg
-75 mg
-150 mg
100
Venlafaxine (Effexor XR) is dosed ____ per day
Once
101
The initial starting dose for Venlafaxine (Effexor XR) is ___ mg XR
75
102
We can increase the dose of Venlafaxine (Effexor XR) by ___ mg every 4-5 days
75
103
The maximum recommended dose of Venlafaxine (Effexor XR) is ____ mg/day
225
104
What are some common side effects of Venlafaxine (Effexor XR)?
-Nausea (37%)
-Headache (25%)
-Somnolence (23%)
-Dizziness (19%)
-Insomnia (18%)
-Constipation (15%)
-Nervousness (13%)
-Sweating (12%)
-Abnormal ejaculation (12%)
-Asthenia (12%)
105
Possible drug interactions with Venlafaxine (Effexor XR):
Possible serotonin syndrome with an SSRI
106
Symptoms of serotonin syndrome:
-Agitation
-Hyperthermia
-Neuromuscular disturbance
-Tachycardia
107
What is an example of a beta-blocker used for anxiety?
Propranolol (Inderal)
108
Propranolol (Inderal) is used for ____ anxiety (stage fright)
Acute
109
Propranolol (Inderal) relieves _____ symptoms such as rapid heartbeat
Autonomic
110
Beta-blockers like Propranolol (Inderal) are used ____ with benzodiazepines
Adjunctive
111
Propranolol (Inderal) can be given in a ___-___ mg dose 1-2 hours prior to a stressful event
10-60
112
Propranolol (Inderal) can also be given in ___-___ mg doses every day for maintenance
80-160
113
What are three types of antidepressants that can be used for anxiety?
-TCA (Imipramine)
-SSRI (first-line therapy for OCD, GAD)
-Duloxetine (Cymbalta)
114
TCA should be given at ____
Bedtime
115
The anticholinergic side effects of TCA limit its use; these include:
-Dry mouth
-Constipation
-Cardiac abnormalities
-Arrhythmias
116
Duloxetine (Cymbalta) has similar effects to ____
Venlafaxine (Effexor XR)
117
Vistaril (hydroxyzine pamoate) has been approved for ____/____
Anxiety/tension
118
Vistaril (hydroxyzine pamoate) is given as ___-___ mg per dose
25-100 mg
119
Vistaril (hydroxyzine pamoate) should be given at a max dose of ___ mg/day
600
120
Vistaril has anxiety-relieving properties that are not related to its sedative effects; it may be related to certain ____ effects
Histaminergic
