Exam 2 Study Guide Flashcards
What are the symptoms for SSRI discontinuation syndrome
(FINISH)
F= Flu like symptoms (aches, pains, chills)
I= Insomnia
N= Nausea
I= Imbalance
S= Sensory disturbance (tremors, sensation of electrical shock)
H= Hyperarousal
What is the first line agent for anxiety disorders? e.g. Social anxiety disorder (SAD)
***First line treatment for chronic anxiety, GAD, panic disorder = SSRI
Treat comorbid depression
Lack abuse risk
Low side effect rate
A patient presents with depressive symptoms alongside pain complaints = what medications
will you consider?
SNRI’s and TCA’s
Highest anticholinergic effect between TCA/BZO/SSRI?
TCA
Venlafaxine (Effexor) notable SEs
can be very activating (patients can be restless)
dose-dependent elevated BP
(NOT anticholinergic)
Tx akathisia
β-adrenergic receptor antagonists (beta-blockers) are generally most effective in thetreatment of Akathisia
(can use BZO but not first line)
Which Serotonergic agent can cause priapism?
Trazodone or escitalopram
Signs serotonin syndrome
muscle spasms, fever, racing heart, headache, and confusion
o S=Shivering
o H=Hyperreflexia/Myoclonic jerks
o I = Increased Temp (Fever)
o V= Vitals Instability (↑↓BP; ↑RR; ↑HR)
o E= Encephalopathy (Confusion)
o R= Restlessness
o S= Sweating (Diaphoresis)
Only tricyclic antidepressant (TCA) thought to be effective in the treatment of obsessive
compulsive disorder (OCD)
clomipramine
Treatment for acute panic attacks =
can use benzo short term in addition to long-term SSRI
performance anxiety tx
propranolol
o CBT
o 1 st line = SSRI or SNRIs
Best meds for GAD (1st/2nd line)
**SSRI (escitalopram, paroxetine) SNRI (duloxetine, venlafaxine)
2nd line= Buspar, SNRI
Can consider short term course of Benzos or augmentation with buspirone (Buspar)
Best meds for SAD
SSRI
Best med for Panic attacks
initially use benzo (short term)
Panic disorder tx (first line, second line, adjunct);what bzo specifically?
Panic disorder
o 1 st line = SSRI, SNRIs
o 2 nd line= TCAs= though limited use
o Adjunct = Benzos USE WITH CAUTION, short-term until other meds reach therapeutic efficacy
alprazolam is FDA approved for panic d/o
OCD tx (first line class & common meds, second line)
Meds + CBT
o 1 st line= SSRI (often need high doses of sertraline, fluoxetine); Luvox
o 2 nd line = SNRI (e.g. venlafaxine) (Clomipramine=Anafranil)
Effects of benzodiazepine use and SE
Enhance activity of GABA at GABA-A receptor
- Potential for abuse and addiction
- Patient become physical dependent and build tolerance
- Can be used to treat Akathisia
- Choice of BDZ depends on time of onset, duration of action and method of metabolism
OTL= Outside The Liver (oxazepam, temazepam, lorazepam) = not metabolized by
the liver - S/E: Anticholinergic, unusual behaviors, hallucinations, daytime drowsiness,
amnesia
MOA of benzodiazepines & what effect does it have on body
MOA: Potentiate effects of GABA (Remember GABA is inhibitory) → drowsiness, cognitive
impairment, dampening of fear and anxiety, impaired balance, moto control, muscle tone
and coordination, anterograde amnesia.
Risk BZO use in elderly
Elderly patients: Increased fall risk, hip fracture risk
What BZO are not metabolized by the liver
OTL= Outside The Liver (oxazepam, temazepam, lorazepam) = not metabolized by
the liver
Benzodiazepine withdrawal symptoms:
Benzo withdrawal is like ETOH withdrawal
* Insomnia
* Anxiety
* Hand tremors
* Irritability
* Anorexia
* Nausea/vomiting
* Autonomic hyperactivity (diaphoresis, tachycardia, HTN)
* Tonic –clonic seizures = life threatening
Note: Abrupt abstinence after chronic use can be life threatening.
A known limitation of Benzo tx for insomnia
rebound insomnia
Short acting BZO half-life, which BZOs, and indication for use
Short Acting = < 6hrs half life
seizure disorders, Panic attacks
midazolam (Versed) and alprazolam (Xanax)
Intermediate acting BZOs half life, which BZOs, and indication for use
6-20 hours half life
insomnia, anxiety
lorazepam, oxazepam, temazepam