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IPAP > FamMed > Flashcards

FamMed Flashcards

1
Q

What are the two principle components of anxiety

? are the most prevalent psych d/os

A 
Psych:   
Difficulty concentrating 
Apprehension
Fear
Tension
Somatic:
Palpitations
Sweat
Tremor
SOB
Tachy/Tachy

Anxiety

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2
Q

Sympathomimetic Sxs of anxiety are a response to what two things

Why do these conditions spiral further down

A

CNS and reinforced anxiety

Pt associated trigger w/ anxiety
Anxiety improves w/ exposure
Never learns trigger doesn’t mean fear

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3
Q

What is a frequent contributing factor to anxiety

What is a common term for this issue

What makes this anxiety worse and why is it a concern

A

Lack of structure

Sunda neuroses- do well w/ scheduled week, poorly w/ unsructured weekend

Planned timed activities bind the anxiety
Bind is lost during retirement

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4
Q

GAD becomes chronic after ? long

What older populations is this even more common in

A

2yrs

2x dementia
4-6x > major depression

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5
Q

Dx criteria for GAD

What systems can the Sxs manifest through

A 
Sxs: 
Somatic complaint
Apprehension 
Irritable 
Dec concentration 
Insomina 
Worry 
More days than not x 6mon

GI Neuro Cardiac

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6
Q

Define Panic Attack

What is an example

What does the ‘alarm response’ manifest as?

A

Intense surge of anxiety w/ physiologic manifestations

Agoraphobia

Impending doom

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7
Q

What is the key to Dx of panic d/os

When can Panic D/o be Dx

All of these Pts also develop ? that further constricts daily living

A

Psychic pain and suffering expressed by Pt

Panic attack w/ chronic fear of recurrence or,
Maladaptive change in behavior to avoid triggers

Anticipatory anxiety

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8
Q

What sub-dx occurs w/ 30% of Panic D/o Dxs

Who is more affected by panic d/os

When are these Pts at ‘hightened’ vulnerability

A

Sleep panic attacks

F>M 2:1 w/ onset at 25

Premenstrual period

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9
Q

Pts w/ Panic d/os can develop ? four issues d/t this Dz

They are also at increased risk for ? two outcomes

If they become abusers of alcohol, ? other abuse is common?

A

Demoralized
Hypochondriac
Agoraphobic
Depressed

Major depression
Suicide

Sedatives

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10
Q

Pts w/ atypical panic attacks that are associated w/ seizure like Sxs often include ?

What usually appears in their Hx during work up

About a quarter of Panic D/o Pts will also have ? Dx

A

Seizure-like Sxs w/ psychosensory phenomenon

Hx of stimulant abuse

OCD

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11
Q

What are first line Txs for GAD

One medication can be reported as ‘too’ activating for these Pts

Over all, why do these classes of drugs tend to work for these Pts

A

SSRI/SNRI

SNRI- Levomilnacipran

Similar to Benzos w/out addiction

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12
Q

Why are anti-depressants considered first line for Tx of GAD

However, when first started, these meds can cause ?, so using ? when starting may help

A

No pyschological dependence

Anxiogenic, benzos

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13
Q

What two SSRIs are FDA approved for GAD Tx

What two SNRIs are FDA approved

What drug classes are second and third line Tx for GAD d/t med interactions and s/e

A

Escitalopram
Paroxetine

Venlafaxine
Duloxetine

TCA, MOAIs

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14
Q

What drug can be used for Tx GAD w/ underlying compulsive d/os

Why is this med maxed out at 30-60mg/day

This med is also the most ? w/out any evidence of ?

A

Buspirone

GI s/e
Dizzy

Anxiogenic
Tx GAD

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15
Q

When Tx GAD and waiting for SSRIs to increase to therapeutic levels, ? may help w/ sleep

? medication can help reduce peripheral somatic Sxs

These Pts tend to self medicate most frequently w/ ?

A

Gabapentin

Propranolol

Alcohol

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16
Q

What meds are first line Tx of Panic D/o

Panic d/o may need to have ? two Benzos used while first initiating Rx Tx

A

SSRI: Fluoxetine Paroxetine Sertraline
SNRI: Venlafaxine

Clonzepam
Alprazolam

17
Q

Long acting Benzos are best used for ?

Intermediate acting ones are best used for ?

Short acting Benzos are best used for ?

A

Alcohol w/drawl
Anxiety Sxs

Insomnia (Lorazepam)

Medical procedures (Midazolam)

18
Q

What is the benefit of using Lorazepam

What is the risk of using ultra-short acting agents like Triazolam

Why do some providers prefer using long acting Benzos like Clonazepam?

A

No active metabolites
T1/2: 10-20hrs
Best for: Geriatric, Liver dysfunction

Rebound withdrawal anxiety

T1/2= 20-120hrs
Once-twice daily dosing

19
Q

If Benzos are taken above levels of sedation, what are the s/e?

If OD is achieved, Pts can die d/t ?

A 
Disinhibition
Ataxia
Nystagmus
Delirium
Dysarthria

Respiratory depression
HOTN
Shock
Coma/Death

20
Q

What medication is used to reverse Benzo OD

Common withdrawal Sxs after low-mod daily Benzo use are classified as ? and include ?

A

Flumazenil

Somatic-
Disturbed sleep
Tremor
Nausea
Muscle aches

Psych:
Anxiety
Irritable
Depressed

Perception:
Coordination
Paranoia
Confusion

21
Q

When Tx resistant Panic D/os w/ anti-depressants, ? med may be used in conjunction

Why is this medication preferred

A

Propranolol

Blocks sympathetic stimulation )palpitations, tremors)
No effect on non-adrenergic Sxs: diarrhea, muscle tension)

22
Q

Define OCD

This is defined as ? type of d/o

What are the definitions of Obsession and Compulsion

A

Pre-occupation or repetitive rituals that distress Pt

Anxiety

O: Distressing thoughts
C: Repetitive actions

23
Q

What are some of the d/os that overlap into the OCD spectrum

OCD has a high comorbidity w/ ? Dx

What Pt populations are at highest risk

A

Tics
Trichotillomania
Excoriation
Body dysmorphic d/o

Major depression

Young Divorced Separated Unemployed

24
Q

What type of Neuro abnormalities are seen in OCD

When stressed, these Pts can become paranoid/delusional and mimic ?

What meds are used for Tx

A

Fine motor coordination
Involuntary movements

Schizophrenia

SSRI and Clomipramine
SSRI adjunct= antipsychs and Topiramate for Tx resistant

25
Q

Low dose of Clomipramide can be used for SSRI adjunct when Tx OCD, but w/ ? risk

When should plasma levels be checked and what levels are desired

What non-Rx Tx is used for OCD Tx

A

Serotonin syndrome

2-3wks later after 50mg/day is achieved
<500ng/mL= toxicity avoidance

Exposure and response prevention
Thought stopping

26
Q

Severe OCD is commonly seen w/ ? disability

What procedure can be used for Tx

A

Vocational

Transcranial magnetic stimulation

IPAP (212 decks)

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