FamMed Flashcards
What are the two principle components of anxiety
? are the most prevalent psych d/os
Psych: Difficulty concentrating Apprehension Fear Tension
Somatic: Palpitations Sweat Tremor SOB Tachy/Tachy
Anxiety
Sympathomimetic Sxs of anxiety are a response to what two things
Why do these conditions spiral further down
CNS and reinforced anxiety
Pt associated trigger w/ anxiety
Anxiety improves w/ exposure
Never learns trigger doesn’t mean fear
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
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
GAD becomes chronic after ? long
What older populations is this even more common in
2yrs
2x dementia
4-6x > major depression
Dx criteria for GAD
What systems can the Sxs manifest through
Sxs: Somatic complaint Apprehension Irritable Dec concentration Insomina Worry More days than not x 6mon
GI Neuro Cardiac
Define Panic Attack
What is an example
What does the ‘alarm response’ manifest as?
Intense surge of anxiety w/ physiologic manifestations
Agoraphobia
Impending doom
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
Psychic pain and suffering expressed by Pt
Panic attack w/ chronic fear of recurrence or,
Maladaptive change in behavior to avoid triggers
Anticipatory anxiety
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
Sleep panic attacks
F>M 2:1 w/ onset at 25
Premenstrual period
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?
Demoralized
Hypochondriac
Agoraphobic
Depressed
Major depression
Suicide
Sedatives
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
Seizure-like Sxs w/ psychosensory phenomenon
Hx of stimulant abuse
OCD
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
SSRI/SNRI
SNRI- Levomilnacipran
Similar to Benzos w/out addiction
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
No pyschological dependence
Anxiogenic, benzos
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
Escitalopram
Paroxetine
Venlafaxine
Duloxetine
TCA, MOAIs
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 ?
Buspirone
GI s/e
Dizzy
Anxiogenic
Tx GAD
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/ ?
Gabapentin
Propranolol
Alcohol
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
SSRI: Fluoxetine Paroxetine Sertraline
SNRI: Venlafaxine
Clonzepam
Alprazolam
Long acting Benzos are best used for ?
Intermediate acting ones are best used for ?
Short acting Benzos are best used for ?
Alcohol w/drawl
Anxiety Sxs
Insomnia (Lorazepam)
Medical procedures (Midazolam)
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?
No active metabolites
T1/2: 10-20hrs
Best for: Geriatric, Liver dysfunction
Rebound withdrawal anxiety
T1/2= 20-120hrs
Once-twice daily dosing
If Benzos are taken above levels of sedation, what are the s/e?
If OD is achieved, Pts can die d/t ?
Disinhibition Ataxia Nystagmus Delirium Dysarthria
Respiratory depression
HOTN
Shock
Coma/Death
What medication is used to reverse Benzo OD
Common withdrawal Sxs after low-mod daily Benzo use are classified as ? and include ?
Flumazenil
Somatic- Disturbed sleep Tremor Nausea Muscle aches
Psych:
Anxiety
Irritable
Depressed
Perception:
Coordination
Paranoia
Confusion
When Tx resistant Panic D/os w/ anti-depressants, ? med may be used in conjunction
Why is this medication preferred
Propranolol
Blocks sympathetic stimulation )palpitations, tremors)
No effect on non-adrenergic Sxs: diarrhea, muscle tension)
Define OCD
This is defined as ? type of d/o
What are the definitions of Obsession and Compulsion
Pre-occupation or repetitive rituals that distress Pt
Anxiety
O: Distressing thoughts
C: Repetitive actions
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
Tics
Trichotillomania
Excoriation
Body dysmorphic d/o
Major depression
Young Divorced Separated Unemployed
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
Fine motor coordination
Involuntary movements
Schizophrenia
SSRI and Clomipramine
SSRI adjunct= antipsychs and Topiramate for Tx resistant
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
Serotonin syndrome
2-3wks later after 50mg/day is achieved
<500ng/mL= toxicity avoidance
Exposure and response prevention
Thought stopping
Severe OCD is commonly seen w/ ? disability
What procedure can be used for Tx
Vocational
Transcranial magnetic stimulation
