Chapter 67: Anxiety Disorders

Question 1

Which key drugs cause anxiety?

Answer 1

Albuterol (if used too frequently or incorrectly)
Antipsychotics (e.g., aripiprazole, haloperidol)
Bupropion
Caffeine, in high doses
Decongestants
Illicit drugs
Levothyroxine (if therapeutic OD occurs)
Steroids
Stimulants
Theophylline

Question 2

What are natural products used for anxiety & their warnings/SE

Answer 2

• St. John’s Wort (strong 3A4 inducer, causes photosensitivity & is serotonergic)
• Valerian (some products may be contaminated with liver toxins)
• Passionflower is safe & “possibly effective”
• Kava (severe liver damage, NOT recommended)

Question 3

Which drug class is recommended first line for anxiety

Answer 3

SSRIs

Question 4

SSRIs will not provide immediate relief of anxiety. They take at least ____ at higher doses for a noticeable effect

Answer 4

4 weeks

Question 5

Which medication is a more favorable add-on medication than BZDs in elderly patients d/t less sedation

Answer 5

Buspirone

Question 6

Buspirone will not provide immediate relief of anxiety. It will take at least ____ for effect

Answer 6

2-4 weeks

Question 7

Which medication can be used short-term, as needed, as an alternative to BZDs

Answer 7

Hydroxyzine (Vistaril)

Question 8

Which medications are not FDA approved for anxiety but has shown benefit in patients with anxiety and neuropathic pain

Answer 8

Pregabalin (Lyrica) & Gabapentin (Neurontin)

Question 9

Which medication is not FDA approved for anxiety but can reduce symptoms of stage fright or performance anxiety (e.g., tremor, tachycardia)

Answer 9

Propranolol (Inderal LA)

Question 10

MOA of buspirone is unknown, but its effects may be due to its affinity for which receptors

Answer 10

5-HT1A and 5-HT2

Question 11

CI for buspirone

Answer 11

Do not use with MAOi within 14 days

Question 12

Which medication used for anxiety could you give someone with a history of drug abuse

Answer 12

Buspirone

Question 13

MOA of BZDs

Answer 13

Enhance GABA, which is an inhibitory neurotransmitter, causing CNS depression

Question 14

Which drug class can be useful for short-term treatment of acute anxiety that is preventing restful sleep and disrupting life (i.e., recent death of a loved one, natural disaster, etc.)

Answer 14

benzodiazepines

Question 15

Due to the risk of dependency, benzodiazepines should only be used for ____ and then discontinued. If used for longer periods of time, they must be tapered off slowly to prevent withdrawal symptoms

Answer 15

1-2 weeks

Question 16

BZDs are inappropriate to use in patients older than 65 years and have a high risk of confusion, dizziness and falls in the elderly. If a BZD is used, which ones are safer to use in elderly patients and patients with liver impairment?

Answer 16

L-O-T

• Lorazepam
• Oxazepam
• Tamezepam

Question 17

What are the preferred BZDs for anxiety in everyone besides elderly and patients with liver impairment?

Answer 17

CLAD

• Clonazepam
• Lorazepam
• Alprazolam
• Diazepam

Question 18

What are the preferred BZDs for sleep

Answer 18

Lorazepam or temazepam

Question 19

Alprazolam brand name

Answer 19

Xanax

Question 20

Clonazepam brand name

Answer 20

Klonopin

Question 21

Diazepam brand name

Answer 21

Valium

Question 22

Lorazepam brand name

Answer 22

Ativan

Question 23

BZD boxed warning

Answer 23

Use with opioids can result in sedation, respiratory depression, coma and death

Question 24

Clonazepam and diazepam have a CI for

Answer 24

severe liver disease

Question 25

Are BZDs safe in pregnancy

Answer 25

No - crosses placenta

Question 26

BZD side effects

Answer 26

Somnolence, dizziness, ataxia

Question 27

What schedule are BZDs

Answer 27

C-IV

Question 28

Which BZDs are commonly used for alcohol withdrawal syndrome?

Answer 28

Lorazepam, diazepam and chlordiazepoxide

Question 29

Antidote for BZDs

Answer 29

Flumazenil

Question 30

Alprazolam is CI with

Answer 30

Strong 3A4 inhibitors (e.g., ketoconazole, itraconazole)

Question 31

Which medication used for anxiety is scored to easily break in half or into thirds?

Answer 31

Buspirone