Exam 4 - Lec 61 Anxiety Ott Flashcards
drugs that can cause anxiety (6)
albuterol
caffeine (high dose)
decongestants
levothyroxine
steroids
stimulants (ADHD meds)
buspirone is an agonist of what receptor?
5HT-1A
buspirone is approved for use in what disorder?
generalized anxiety disorder (GAD)
(can be first line)
buspirone dose for GAD
10-15 mg TID (30-45 mg total/day)
how long does it take for buspirone to work? (range)
3-4 weeks
which BZDs do not have an active metabolite? (4 of them bolded)
alprazolam
lorazepam
clonazepam
oxazepam
which BZDs have a long-acting active metabolite? (3 of them)
diazepam
clorazepate
chlordiazepoxide
T or F: d/c of BZDs requires a slow taper over weeks to months
T
look at slide 7 for SE of BZDs
ok
T or F: according to the Beer’s Criteria, BZDs may be inappropriate in the elderly
T (but there are some we can still use)
preferred BZDs in the elderly (3 of them)
lorazepam
oxazepam
temazepam
T or F: hydroxyzine pamoate is FDA-approved for GAD
T
_________ is most commonly used PRN for anxiety or insomnia instead of a BZD
hydroxyzine
SE of hydroxyzine
prominent sedation and anticholinergic effects, QTc prolongation risk
T or F: hydroxyzine is preferred in the elderly for GAD
F (avoid in elderly due to anticholinergic SE and fall risk)
which of the following is FALSE about propranolol?
a. decreases physiological sx of acute anxiety
b. useful for performance and situational anxiety
c. used in high doses
d. evaluate for asthma and CV conditions
c. used in high doses (low doses)
look at slide 10 for natural products
okay
T or F: gabapentinoids are NOT considered in pt with bipolar disorder who has anxiety sx or comorbid neuropathic pain
F (can be considered)
T or F: sleep medicine does NOT endorse the use of quetiapine for insomnia
T
first line drug therapy for all anxiety disorders (two classes)
SSRIs and SNRIs
T or F: BZDs are NOT FDA-approved for anxiety
F (FDA-approved, but use only if necessary)
T or F: atypical antipsychotics are FDA-approved for anxiety disorders
F (but evidence suggest efficacy for tx-resistant OCD - aripiprazole and risperidone)
two atypical antipsychotics for treatment-resistant OCD
aripiprazole and risperidone
for GAD to be diagnosed, how long must excessive anxiety be present?
at least 6 months
GAD symptoms (there are 6 of them; must meet at least 3; slide 13)
-restlessness/feeling on edge
-easily fatigued
-difficulty concentrating or mind “going blank”
-irritability
-muscle tension
-sleep disturbances
when can SNRI antidepressants be used first-line for GAD?
if pt also has a pain syndrome
what role do BZDs play in GAD when used with a SSRI/SNRI?
bridge therapy to cover time until onset of SSRI/SNRI (must taper if pt been taking long term)
how long for SSRIs to work for GAD? (range)
2-4 weeks
how long must symptoms be present to be diagnosed with Social Anxiety Disorder?
at least 6 months
which two SSRIs are approved for tx of Social Anxiety Disorder?
paroxetine
sertraline
which SNRI is approved for tx of Social Anxiety Disorder and is usually second line if SSRI fails?
venlafaxine
which disorder includes an abrupt surge of intense fear or discomfort and must have at least 4 physical and psychological sx, including sweating, palpitations, nausea, dizziness, fear of losing control, “going crazy”, or dying?
a. GAD
b. Social Anxiety Disorder
c. Panic Disorder
d. OCD
c. Panic Disorder
Look at slide 17 for more info on Panic Disorder
Ok
_____ are first line maintenance tx for Panic disorder
SSRIs
step-wise therapy for Panic Disorder
SSRI -> SNRI (venlafaxine) -> BZD (clonazepam/alprazolam)
which of the following is TRUE about the tx of OCD?
a. SNRIs are first line
b. 50-75% reduction in sx expected
c. clomipramine is second line
d. antipsychotics are FDA-approved for OCD
c. clomipramine is second line
(a is SSRI; b is 25-50%; d is not approved, but may be considered as augmentation therapy with SSRIs/SNRIs)
which antipsychotic has the best clinical data for effectiveness when used as augmentation therapy for OCD?
a. haloperidol
b. risperidone
c. aripiprazole
d. quetiapine
e. olanzapine
b. risperidone
4 cardinal symptoms of PTSD
-flashbacks/reexperiencing
-avoidance
-hypervigilance (basically being on high alert)
-negative alterations in mood or cognition
which of the following is FALSE about PTSD?
a. SSRIs/SNRIs are first line
b. doxazosin may be helpful for sleep or nightmares
c. BZDs are not recommended
d. polytherapy and substance use is common
e. CBT and eye movement desensitization and reprocessing may be helpful
b. doxazosin may be helpful for sleep or nightmares
(prazosin, not doxazosin)
“________” syndrome can result from use of SSRIs and SNRIs when treating anxiety disorders, and initial doses should be lower than those for depression to minimize SE
“jitteriness”
T or F: abrupt d/c of BZDs can be life-threatening
T
T or F: psychotherapy and CBT are mainstays of tx for anxiety disorders
T
in PTSD, drug therapy may be more effective in _______ trauma versus _______ trauma, so non-drug txs are especially useful
civilian; combat
(civilian trauma is usually one-time event; combat trauma has events occurring over longer period of time)
