Ch 35 Drugs for Anxiety Flashcards
Anxiety is an uncomfortable state that has psychologic
manifestations (4) and physical manifestations (8).
fear, apprehension, dread, uneasiness
tachycardia, palpitations, trembling, dry mouth, sweating, weakness, fatigue, shortness of breath
When anxiety is (2), intervention is
indicated.
persistent and disabling
As a rule, optimal therapy of anxiety disorders consists of
(2).
psychotherapy combined with drug therapy
The drugs used most often for anxiety disorders are
(2).
serotonergic reuptake inhibitors and benzodiazepines
___ are used primarily for panic disorder (PD) and generalized anxiety disorder (GAD).
___ are used for all anxiety disorders
Benzodiazepines
SRIs
GAD (generalized anxiety disorder) is a chronic condition characterized by __.
uncontrollable worrying
First-line drugs for GAD are (3).
SRIs, buspirone, and benzodiazepines
__ are especially well suited for treating patients who have depression in addition to GAD. However, they are also effective even when depression is absent.
SRIs (venlafaxine, paroxetine, escitalopram, and duloxetine)
With buspirone, venlafaxine, paroxetine, escitalopram, and duloxetine, anxiolytic effects are delayed. Accordingly, these drugs are best suited for __.
long-term management—not rapid relief
Buspirone has three advantages over benzodiazepines:
It does not cause CNS depression,
has no abuse potential, and
does not intensify the effects of CNS depressants.
Buspirone levels can be increased by (3).
erythromycin, ketoconazole, and grapefruit juice
Benzodiazepines suppress symptoms of GAD __.
immediately.
Accordingly, these drugs are preferred agents for rapid stabilization, especially when anxiety is severe.
__ are CNS depressants and hence can
cause sedation and psychomotor slowing. In addition,
they can intensify CNS depression caused by other
drugs.
Benzodiazepines
Benzodiazepines have some potential for abuse, and hence should be used with caution in patients __.
known to abuse alcohol or other psychoactive drugs
When taken long term, benzodiazepines can cause __.
physical dependence.
To minimize withdrawal symptoms, dosage should be tapered gradually—over a period of several months.
Patients with panic disorder experience recurrent __.
panic attacks, characterized by palpitations, pounding heart, chest pain, derealization or depersonalization, and fear of dying or going crazy
Many patients with panic disorder also experience agoraphobia, a condition characterized by __.
anxiety about being in places or situations from which escape might be difficult or embarrassing, or in which help might be unavailable if a panic attack should occur
__ are first-line drugs for panic disorder.
SSRIs
SSRIs decrease the frequency and intensity of (3), and they work regardless of whether the patient has depression.
panic attacks, anticipatory anxiety, and avoidance behavior
Obsessive-compulsive disorder (OCD) is characterized by:
persistent obsessions and compulsions that cause marked distress, consume at least 1 hour a day, and significantly interfere with daily living
__ are first-line drugs for OCD.
SSRIs
Social anxiety disorder, formerly known as social phobia, is characterized by __.
an intense, irrational fear of being scrutinized by others or of doing something that could be embarrassing or humiliating
The __ are first-line drugs for most patients with social
anxiety disorder.
SSRIs
When social anxiety disorder is limited to fear of speaking or performing in public and when these situations arise infrequently, PRN treatment with a __ may be preferred to long-term treatment with an SSRI.
benzodiazepine
Post-traumatic stress disorder (PTSD) develops following
a __.
traumatic event that elicited an immediate reaction of
fear, helplessness, or horror
PTSD has three core symptoms:
re-experiencing,
avoidance/emotional numbing, and
hyperarousal
Events that can lead to __ include physical or sexual
assault, rape, torture, combat, industrial explosions, serious accidents, natural disasters, being taken hostage, displacement as a refugee, and terrorist attacks.
PTSD
According to a VA/DoD guideline, PTSD can be treated with _(2)_.
psychotherapy and with drugs
__ are approved by the FDA for first-line drug treatment of PTSD. Additional drugs used for treatment of PTSD include venlafaxine (an SNRI), TCAs, and MAOIs.
Two SSRIs (paroxetine and sertraline)
