Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Spring 2024 Therapeutics 3 > Exam 4 Anxiety > Flashcards

Exam 4 Anxiety Flashcards

1
Q

When do we treat anxiety?

A

-When it interferes with normal life

-When it interferes with part of another disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What substances or actions can cause anxeity?

A

Caffeine

-Cell phone/Social Media withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which neurotransmitters are involved in anxiety?

A

Norepinephrine (NE)

Serotonin

Corticotropin-Releasing Factor (CRF) and the HPA axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does Norepinephrine cause anxiety?

A

Over-active

*Projects to the amygdala (fear center)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What part of the brain is responsible for anxiety?

A

amygdala (fear center)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the role of GABA in anxiety?

A

-Normally counteracts the stimulatory effects of excess norepinephrine

*Hypothesis that reduced GABA signaling is responsible for anxiety

*Anxiolytics increase GABA signaling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What affect does GABA have (Inhibitory or Excitatory)?

A

Inhibitory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What effect does Glutamate have (Inhibitory or Excitatory)?

A

Excitatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What converts glutamate to GABA?

A

Glutamic Acid Decarboxylase

(used in GAD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the drug treatment used for anxiety?

A

-Benzodiazepines
-Antidepressants
-Buspirone
-Beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How fast do benzodiazepines work?

A

QUICK, effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How fast do antidepressants work?

A

TAKE WEEKS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the new breakthrough antidepressant used for anxiety?

A

Ketamine
(nasal spray esketamine)

*Very quick acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the MOA of Buspirone?

A

Partial agonist on brain 5HT 1A receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the adaptive response of Buspirone?

A

Has a longer onset of action than benzodiazepines

*Takes mush longer to work, not good for panic disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

True or False: Buspirone has a low abuse potential

A

TRUE
-because it targets the 5HT 1A receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the beta blocker of choice for anxiety?

A

Propranolol (Inderal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What do we need to be aware of when starting propranolol?

A

*May need initial test dose

(titrate so that patient is not put to sleep)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Relating to anxiety, what is propranolol especially good at treating?

A

Decreased peripheral symptoms of anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are promising investigational anxiolytics?

A

Glutamatergic agents

*glutamate is not targeted yet but being developed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What drugs cause anxiety?

A

-Albuterol
-Caffeine (high dose 800mg or more)
-Decongestants
-Levothyroxine
-Steroids
-Stimulants (ADHD) meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is Buspirone’s approved use?

A

Generalized Anxiety Disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the target dose of Buspirone?

A

10-15mg TID

(30-45 mg total/day)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How long does it take for Buspirone to be effective?

A

Up to 3-4 weeks

*patients often need higher doses to see effectiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What do treatment guidelines say about using benzodiazepines for anxiety?

A

-Many guidelines do not support their use in routine practice due to misuse potential

*But the effect size for efficacy in anxiety disorders is higher than serotonergic antidepressants in some studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is a limitation to using benzodiazepines?

A

Long-term use is not recommended

(dependence/tolerance risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

True or False: Benzodiazepines cause withdrawal symptoms

A

TRUE
-can lead to life-threatening seizures
*requires slow taper off over weeks to months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the warnings associated with benzodiazepines?

A

Warning with concomitant use with other CNS depressants and overdose death risk

*specific warning for co-prescribing with opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which benzodiazepines do not have an active metabolite?

A

Alprazolam
Lorazepam
Clonazepam
Oxazepam

**less likely to accumulate
**less fall risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which benzodiazepines have a long-acting active metabolite?

A

Diazepam
Clorazepate
Chlordiazepoxide

31
Q

What are the side effects of benzodiazepines?

A

-Sedation
-Paradoxical excitement
-Swallowing difficulties
-Impairment of memory and recall
-Psychomotor impairment

32
Q

Who should possibly not receive benzodiazepines?

A

Elderly

33
Q

Which benzodiazepines are preferred in the elderly?

A

L-O-T

Lorazepam
Oxazepam
Temazepam

34
Q

What is Hydroxyzine approved for?

A

GAD

35
Q

How do you take hydroxyzine?

A

PRN

*for anxiety and insomnia

36
Q

What are the side effects of hydroxyzine?

A

-Sedation
-Anticholinergic
*QTc prolongation
*Fall risk

37
Q

Who should not receive hydroxyzine?

A

Elderly

(due to anticholinergic SE and fall risk)

38
Q

What is propranolol used for?

A

Decreases the physiological symptoms associated with anxiety (tachycardia, sweating, flushing)

*Performance and Situational anxiety

39
Q

What is the dosing of propranolol used?

A

*Low doses

*Used prn

40
Q

What should be evaluated in patients to decide eligibility for propranolol?

A

-Evaluate for history/current asthma
-Evaluate for cardiovascular conditions

41
Q

What are the natural products used for anxiety?

A

Kava
St. John’s Wort
Valerian
Passionflower
Chamomile

42
Q

What side effects can Kava cause?

A

Hepatotoxicity + Liver failure

-Platelet aggravation
-Aggravates Parkinson’s symptoms

*use not recommended

43
Q

What is the MOA of St. John’s Wort?

A

Strong 3A4 inducer

*watch drug interactions

44
Q

Who should avoid taking valerian?

A

Pregnant women

45
Q

When should passionflower be avoided and why?

A

Pregnancy
-due to risk of uterine stimulation and induction of early labor

46
Q

Who should avoid chamomile?

A

*Patients taking blood thinners
*Patients with ragweed allergy

47
Q

When should we consider gabapentinoids?

A

Patient with bipolar disorder who has anxiety or comorbid neuropathic pain

48
Q

When should we consider quetiapine?

A

*Active metabolite theoretically has anti-anxiety properties

*Not something we really use

*Sleep medicine does not endorse its use for insomnia

49
Q

What are the first-line options for anxiety disorders?

A

SSRIs

SNRIs

Buspirone

50
Q

Which drugs are NOT approved for anxiety disorders but may be efficacious with treatment-resistant OCD?

A

Atypical antipsychotics

51
Q

What is the definition of Generalized Anxiety Disorder?

A

Excessive anxiety/worry present for at least 6 months

Must include 3 of the following:
-Restlessness/Feeling keyed up or on edge
-Easily fatigued
-Difficulty concentrating or mind “going blank”
-Irritability
-Muscle tension
-Sleep disturbances

52
Q

What is first-line maintenance treatment for GAD?

A

SSRI antidepressants

53
Q

How long do SSRI’s take to work?

A

2-4 weeks

54
Q

When are SNRIs first-line for GAD?

A

If patient also has a pain syndrome

55
Q

How are benzodiazepines used for GAD?

A

“Bridge Therapy”

-covers time until SSRI/SNRI has effect

56
Q

Which drug can be used prn for GAD?

A

Hydroxyzine

57
Q

What is social anxiety disorder?

A

Persistent fear about social and/or performance situations in which the patient fears embarrassment or humiliation that is unreasonable

*patient may avoid situations and it can affect their routine

*DURATION OF SYMPTOMS AT LEAST 6 MONTHS

58
Q

What is the first-line treatment for social anxiety disorder?

A

SSRI’s

59
Q

When do we use beta-blockers with social anxiety disorder?

A

Non-generalized, performance-related SAD

60
Q

What is Panic Disorder?

A

Recurrent, unexpected panic attacks

-Abrupt surge of intense fear or discomfort

*Includes both physical and psychological symptoms

*At least one attack has been followed by one month or more of at least one of the following:
—Persistent concern about additional attacks
–Significant maladaptive behavior change

61
Q

What is first-line therapy for panic disorder?

A

SSRI’s

62
Q

Which SNRI is FDA approved for panic disorder?

A

Venlafaxine

63
Q

What drugs are first-line for OCD?

A

SSRIs

64
Q

What % reduction in OCD symptoms can be expected?

A

25-50%

65
Q

What drug is considered second-line for OCD?

A

Clomipramine

(if patient fails SSRIs)

66
Q

What role do antipsychotics have in OCD?

A

*Are not FDA approved

*Augmentation therapy with SSRIs/SNRIs

67
Q

Which antipsychotics have the best evidence for OCD use?

A

-Risperidone
-Aripiprazole

68
Q

What is the first-line treatment for PTSD?

A

SSRIs/SNRIs

69
Q

What can we use Prazosin for?

A

Can be helpful for sleep or nightmares with PTSD

70
Q

What drug class is NOT recommended for PTSD?

A

Benzodiazepines

(they work but we do not use because of substance abuse)

71
Q

What therapies can be helpful with PTSD?

A

Cognitive behavioral therapy

Eye movement desensitization and reprocessing

72
Q

What symptom can occur when using SSRIs or SNRIs for anxiety?

A

Jitteriness

**initial doses should be lower than those used for depression

73
Q

What are the mainstays of treatment for anxiety disorders?

A

Psychotherapy and Cognitive Behavioral Therapy

74
Q

In which type of trauma may drug therapy be more useful in PTSD?

A

More effective in civilian trauma (one time event) than combat trauma

Spring 2024 Therapeutics 3 (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions