Chapter 67: Anxiety Disorders Flashcards
Which key drugs cause anxiety?
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
What are natural products used for anxiety & their warnings/SE
- 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)
Which drug class is recommended first line for anxiety
SSRIs
SSRIs will not provide immediate relief of anxiety. They take at least ____ at higher doses for a noticeable effect
4 weeks
Which medication is a more favorable add-on medication than BZDs in elderly patients d/t less sedation (for anxiety)
Buspirone
Buspirone will not provide immediate relief of anxiety. It will take at least ____ for effect
2-4 weeks
Which medication can be used short-term, as needed, as an alternative to BZDs for anxiety
Hydroxyzine (Vistaril)
Which medications are not FDA approved for anxiety but has shown benefit in patients with anxiety and neuropathic pain
Pregabalin (Lyrica) & Gabapentin (Neurontin)
Which medication is not FDA approved for anxiety but can reduce symptoms of stage fright or performance anxiety (e.g., tremor, tachycardia)
Propranolol (Inderal LA)
MOA of buspirone is unknown, but its effects may be due to its affinity for which receptors
5-HT1A and 5-HT2
may take 2-4 weeks to see effectiveness
CI for buspirone
Do not use with MAOi within 14 days
Which medication used for anxiety could you give someone with a history of drug abuse
Buspirone
MOA of BZDs
Enhance GABA, which is an inhibitory neurotransmitter, causing CNS depression
hydroxyzine used in anxiety
SEs?
long or short-term use?
anticholingeric effects
should NOT be used lont-term
Which drug class can be useful for short-term treatment of acute anxiety that is preventing restful sleep and disrupting life
benzodiazepines
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
1-2 weeks
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?
L-O-T
- Lorazepam
- Oxazepam
- Tamezepam
What are the preferred BZDs for anxiety in everyone besides elderly and patients with liver impairment?
CLAD
- Clonazepam
- Lorazepam
- Alprazolam
- Diazepam
What is the preferred BZD for sleep
Temazepam
Alprazolam brand name
Xanax
Clonazepam brand name
Klonopin
Diazepam brand name
Valium
Lorazepam brand name
Ativan
BZD boxed warning
- Use with opioids can result in sedation, respiratory depression, coma and death
- abuse and misuse
- physical dependence, withdrawal symptoms
Clonazepam and diazepam have a CI for
severe liver disease
Are BZDs safe in pregnancy?
No - crosses placenta
BZD side effects
Somnolence, dizziness, ataxia
What DEA schedule are BZDs?
C-IV
Which BZDs are commonly used for alcohol withdrawal syndrome?
Lorazepam, diazepam and chlordiazepoxide
Antidote for BZDs
Flumazenil
Alprazolam is CI with
Strong 3A4 inhibitors (e.g., ketoconazole, itraconazole)
G PACMAN
Which medication used for anxiety is scored to easily break in half or into thirds?
Buspirone
