Dr. Hager: Pharmacotherapy of Anxiety Disorders Flashcards
Excoriation Disorder
- Compulsive skin picking
- With NO obsessive component
Trichotillomania
- Compulsive hair pulling
- With NO obsessive component
Treatment Approach for Anxiety Disorders
- Start with psychotherapy
- Move to medication therapy if needed
Generalized Anxiety Disorder Treatments
1) Psychotherapy
2) Hydroxyzine (Atarax, Vistaril)
3) SSRI/SNRI
4) Pregabalin (Lyrica)
5) Benzodiazepine
6) Buspirone (BuSpar)
Fluoxetine (Prozac) MoA
-SSRI
Sertraline (Zoloft) MoA
-SSRI
Citalopram (Celexa) MoA
-SSRI
Escitalopram (Lexapro) MoA
-SSRI
Paroxetine (Paxil) MoA
-SSRI
Fluvoxamine (Luvox) MoA
-SSRI
Vortioxetine (Trintellix) MoA
- SSRI
- 5HT1A partial agonist
Vilazodone (Viibryd) MoA
- SSRI
- 5HT1A partial agonist
Venlafaxine (Effexor) MoA
-SNRI
Desvenlafaxine (Pristiq) MoA
-SNRI
Duloxetine (Cymbalta) MoA
-SNRI
Milnacipran (Savella, Ixel) MoA
-SNRI
Serotonin Syndrome
- Rare
- Discontinue the causative med
- Use benzodiazepine too
Serotonin Withdrawal Syndrome
-Malaise, headache, tremors, sleep disturbances, anxiety
-Causative agents
Venlafaxine (Effexor)
Paroxetine (Paxil)
Sertraline (Zoloft)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
-Treatment: Start fluoxetine (Prozac) and Taper
Trazodone (Desyrel) MoA
-5HT2 Antagonist
Nefazodone (Serzone) MoA
-5HT2 Antagonist
Mirtazapine (Remeron) MoA
-5HT2 Antagonist
Buspirone (BuSpar) MoA
-5HT1A agonist
Hydroxyzine (Vistiril/ Atarax) MoA
-5HT2 Antagonist
Alprazolam (Xanax) MoA
-Short acting benzodiazepine
Oxazepam (Serax) MoA
-Short acting benzodiazepine
Temazepam (Restoril) MoA
-Short acting benzodiazepine
Lorazepam (Ativan) MoA
-Medium acting benzodiazepine
Diazepam (Valium) MoA
-Long acting benzodiazepine
Clonazepam (Klonopin) MoA
-Long acting benzodiazepine
Chlordiazepoxide (Librium) MoA
-Long acting benzodiazepine
Possible side effects of benzodiazepines
- Sedation
- Ataxia
- Disinhibition
- Repiratory suppression
- Decreased REM sleep
Are Benzodiazepines safe in pregnancy?
-NOOOOO
Treatments for Panic Disorder
1) Psychotherapy
2) SSRI/SNRI
3) Imipramine (TCA)
4) Benzodiazepine
Imipramine (Tofranil)
-TCA
Clomipramine (Anafranil) MoA
-TCA
Amitriptyline (Elavil) MoA
-TCA
Doxepin (Sinequan) MoA
-TCA
Trimipramine (Surmontil)
-TCA
Desipramine (Norpramin)
-TCA
Nortriptyline (Nortrilen)
-TCA
Protriptyline (Vivactil) MoA
-TCA
Maprotyline (Ludiomil) MoA
-TCA
Amoxapine (Asendin) MoA
-TCA
Treatment of Social Anxiety Disorder
1) Psychotherapy
2) SSRI/SNRI
3) Gabapentinoid
4) Benzodiazepine
5) MAOI
Isocarboxazid (Marplan) MoA
-MAOI
Phenelzine (Nardil) MoA
-MAOI
Tranycypromine (Parnate)
-MAOI
Selegiline (Zelepar) MoA
-MAOI
Possible side effects of MAOIs
- Hypertensive crisis
- Diastolic BP > 120
Linezolid (Zyvox) MoA
-MAOI
Give an example of some foods that contain tyramine and must be avoided when taking MAOI
- Aged cheese
- Smoked meat
- MSG
- Fermented fruit, veggies, soy
- Unfiltered beer, wine
- Dark chocolate
List some foods that are safe to eat when taking an MAOI
- Fresh/Frozen/Canned fruits/veggies
- Cottage/ricotta cheese
- Yogurt
- Ice cream
- Milk
- Nuts
- Peanut butter
Which drugs will not increase the risk of serotonin syndrome when given with MAOIs
- Benzodiazepines
- Diphenhydramine
What are some side effects associated with MAOIs
- Orthostatic hypotension
- Hypertensive crisis
- Agitation/sedation
- Insomnia/hypersomina
- GI/ sexual side effects
What is a sufficient washout period for most antidepressants?
-10 to 14 days
Acute Stress Disorder Treatments
- Cognitive Behavioral Therapy
- Prolonged Exposure Therapy
What agents are INEFFECTIVE in treatment of acute stress disorder
- SSRIs
- Propranolol
- Benzodiazepines
PTSD Treatments
1) Psychotherapy
2) SSRI/SNRI
3) Prazosin Augmentation
4) TCAs
5) Antipsychotic augmentation?
Effects of Benzodiazepines in PTSD
- INEFFECTIVE
- Worsen PTSD severity
- Aggression
- Depression
- Substance abuse
OCD Treatments
1) Psychotherapy
2) SSRI/SNRI
3) Clomipramine
4) Augmentation with Risperidone or Quetiapine
In which disease states are benzodiazepines safe and effective
-Panic disorder
What are some side effects associated with Clomipramine
- Orthostatic hypertension
- Blurry vision
- Sedation
- Constipation
- QTc elongation
What are some contraindications for treatment with imipramine
- Intraventricular conduction delay
- Evidence of recent MI
- QTc interval >450ms
Agents associated with weight gain
- Olanzapine
- Gabapentin
- Amitriptyline
- Mirtazipine
- Quetiapine
- Risperidone
Agents associated with weight loss
- Topiramate
- Bupropion
- Fluoxetine
Which disease states do we NOT use benzodiazepines
- PTSD
- OCD
