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PR3153 > IC 15 - Anxiety and Sleep Disorder > Flashcards

IC 15 - Anxiety and Sleep Disorder Flashcards

1
Q

What are anxiety disorders characterized by?

A

Severe, excessive, persistent anxiety and irrational fears that impairs functioning

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2
Q

How long does anxiety disorders lasts?

A

> 6 months

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3
Q

What are the 5 anxiety disorders that are amendable to drug treatments?

A
  1. Panic disorder
  2. Social Anxiety
  3. Generalized Anxiety
  4. OCD
  5. PTSD
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4
Q

What regulates the fear and worry circuit?

A

Amygdala (Fear)
Cortico-striatal-thalamic cortical loop (Worry)

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5
Q

What are the three neurotransmitters involved in anxiety disorders?

A
  1. Norepinephrine
  2. Serotonin
  3. GABA
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6
Q

List 4 medical conditions/categories associated with anxiety

A
  1. CVS (e.g. HF)
  2. Endocrine (e.g. hyperthyroidism)
  3. Neurologic (e.g. dementia and delirium)
  4. Pulmonary (asthma, COPD)
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7
Q

What is panic attack?

A

A discrete period of intense fear/ discomfort where someone experience 4 or more panic symptoms abruptly and reach peak within 10 minutes, lasting for up to 30 minutes

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8
Q

What is generalized anxiety disorder?

A

Excessive anxiety and worry occurring more days than not for ≥ 6 months about a number of events or activities.

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9
Q

List the 6 symptoms associated with GAD?

A
  1. Restless/ on the edge
  2. Fatigue
  3. Difficulty concentrating
  4. Irritable
  5. Muscle tension
  6. Sleep disturbance
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10
Q

What is panic disorder?

A
  1. Recurrent unexpected panic attacks
  2. Persistent anticipatory anxiety of another episode
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11
Q

What are social anxiety disorder?

A

Marked and persistent fear of ≥ 1 social/; performance situations and possible scrutiny by others that will be humiliating and embarrassing.

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12
Q

What are the clinical presentations of social anxiety disorders?

A

Avoidance/ endurance with intense anxiety/ distress of feared social/ performance situations that impair function.

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13
Q

What is the clinical presentation of OCD?

A
  1. Obsessions: recurrent and persistent thoughts/ impulses/ images that are intrusive and inappropriate and causes marked anxiety and distress
  2. Compulsions: Repetitive behaviors or mental acts that are unrealistic, excessive and aimed to prevent or reduce distress.
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14
Q

What are the clinical presentation of PTSD?

A
  1. Persistent re-experiencing of intrusion symptoms
  2. Avoidance of trauma-related stimuli
  3. Negatively altered cognitions and mood (e.g. “ I am bad”
  4. Altered arousal and reactivity (e.g. self harm)
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15
Q

How long should symptoms for PTSD persist?

A

> 1 month

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16
Q

What is the main non-pharmacologic therapy that is used for most anxiety disorder?

A

Cognitive Behavioral Therapy

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17
Q

Cognitive Behavioral Therapy is used ______ with medications.

A

in conjunction

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18
Q

What are the possible pharmacotherapy for GAD?

A
  1. SSRIs
  2. Venlafaxine XR
  3. Pregabalin
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19
Q

Which class of medications can be used for panic, social anxiety disorder, and PTSD?

A

SSRIs

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20
Q

What are the medications that can be used for OCD?

A
  1. SSRIs
  2. Clomipramine
  3. Venlafaxine
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21
Q

List three classes of drugs that are useful for long-term management of anxiety disorders, OCD and PTSD.

A
  1. SSRIs
  2. SNRIs
  3. Clomipramine
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22
Q

What is one side effects that patients can experience after starting antidepressant for the first 1 to 2 weeks?

A

Jitteriness

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23
Q

What is the recommended adjunct therapy for anxiety disorders?

A

Benzodiazepines

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24
Q

Serotonergic antidepressants are suitable for symptoms in anxiety associated with _________.

A

excessive worrying

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25
Q

What is the duration of anxiety disorder treatment?

A

1 to 2 years, typically long-term

26
Q

When will full response of serotonergic antidepressants be achieved for anxiety disorders?

A

3 months

27
Q

What are benzodiazepines useful for in treatment of anxiety disorders?

A

Physical symptoms (e.g. muscle tension)

28
Q

How long are benzodiazepines given to treat anxiety disorders?

A

Short term ( 3 to 4 months) of treatment PRN

29
Q

_____ is required for benzodiazepines to prevent dependence.

A

Gradual tapering

30
Q

What are the high potency benzodiazepines that can be used in anxiety disorders? List three.

A

Clonazepam
Lorazepam
Alprazolam (usually for panic disorder)

31
Q

Name the SSRIs that are FDA approved for GAD.

A

Escitalopram
Paroxetine

32
Q

Name the SNRIs that are FDA approved for GAD.

A

Venlafaxine XE, duloxetine

33
Q

Which antihistamines can be given as anxiolytic or hypnotic for GAD?

A

Hydroxyzine

34
Q

List one anticonvulsants that can be used for GAD.

A

Pregabalin

35
Q

What is the SNRI that is FDA approved and can be used for PD and Social anxiety attack?

A

Venlafaxine XR

36
Q

What are the SSRIs that are FDA approved and can be used for PD?

A

Fluoxetine, Paroxetine, Sertraline

37
Q

What are the SSRIs that are FDA approved and can be used for SAD?

A

Fluvoxamine, Paroxetine, Sertraline

38
Q

What are the SSRIs indicated for OCD?

A

Fluoxetine, fluoxamine, Paroxetine, Sertraline

39
Q

What are the SSRIs approved by FDA for treatment of PTSD?

A

Paroxetine, Sertraline

40
Q

What are some general DDI of anti-depressants?

A
  1. Alcohol and CNS depressants
  2. Anticholinergics
  3. MAOIs and SSRIs/ TCAs combinations - serotonin syndrome
41
Q

What are some DDI that may occur for benzodiazepines?

A
  1. CNS depressants
  2. Opioid (increased mortality)
42
Q

What is the hormone that are secreted during sleep?

A

Melatonin

43
Q

What are the 5 neurotransmitters that promotes alertness?

A

NE, DA, Ach, Histamine, Orexin

44
Q

What is insomnia disorders?

A

Inability to initiate or maintain sleep, associated with daytime problems

45
Q

What are the primary complains of unsatisfying sleep quantity or quality ?

A
  1. Difficulty with sleep initiation
  2. Difficulty with sleep maintenance
  3. Early-morning awakening
46
Q

How long should symptoms for insomnia occur?

A

At least 3 nights per week and present for at least 3 months

47
Q

Acute sleep insomnia is likely due to ____ .

A

acute stressor

48
Q

What are the management for acute transient (< 1week) insomnia?

A

Sleep hygiene

49
Q

What is the management for acute short term (<4weeks) insomia?

A

Short PRN course of hypnotics for 7 to 10 days

50
Q

What are the causes of chronic insomnia?

A

Secondary to underlying psychiatric and/or medical problems

51
Q

What are the medications that can be used for treatment of insomnia?

A
  1. Fast acting anxiolytics/ sedatives/ hypnotics (adjuncts)
52
Q

What is the duration of treatment of insomnia?

A

1 to 2 weeks

53
Q

What is the first line treatment for non-pharmacological treatment for insomnia?

A

Sleep hygiene

54
Q

List two benzodiazepines that can be used as hypnotics for insomnia.

A

Lorazepam and Diazepam

55
Q

List two Z-hypnotics that can be used for insomnia.

A

Zolpidem and Zopiclone

56
Q

What is one side effect of Zopiclone?

A

Taste disturbance

57
Q

What is one side effects of Z-hypnotics?

A

Complex sleep behaviors

58
Q

List two antihistamines that may be used for insomnia.

A

Promethazine, hydroxyzine

59
Q

Which populations are Lemborexant contraindicated in?

A

Narcolepsy, severe hepatic impairment and moderate-strong CYP3A inhibitors

60
Q

List one group of patients that cannot be given benzodiazepines?

A

Respiratory depression

PR3153 (16 decks)

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