Brainscape's Knowledge GenomeTM

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


See full index

53 Finals > IC15 Anxiety and Sleep Disorder > Flashcards

IC15 Anxiety and Sleep Disorder Flashcards

1
Q

definition of anxiety disorder

A

severe, excessive, persistent anxiety and irrational fears that impairs functioning with everyday life
- anxiety is out of proportion to the actual danger or threat of the situation

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

define Generalised Anxiety Disorder (GAD)

A

excessive anxiety and worries ≥6 mths

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

define Panic Disorder (PD)

A

panic attack + anticipatory anxiety

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

define Social Anxiety Disorder (SAD)

A
  • fear of being scrutinised or humiliated by others in public, okay to be alone
  • Differential dx: paranoid (in schizophrenia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

define Obsessive Compulsive Disorder (OCD)

A
  • obsessional thoughts/ impulses that causes anxiety + compulsive behaviours to relieve that anxiety
  • obsession/ compulsion/ both → no need to have both to classify as OCD
  • obsession/compulsion that cause marked distress are time consuming (≥1 hr per day) or significantly impairs functioning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

define Post Traumatic Stress Disorder (PTSD)

A
  • re-experiencing of trauma, persistent avoidance, increased arousal
  • must have a trauma (either experienced/ witness)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

pathophysiology of anxiety

A
  • “fear circuit” (regulated by amygdala — helps to recall things) and “worry-circuit”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

types of neurochemical that are dysregulated in the fear/worry circuit

A

norepinephrine, serotonin, GABA

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

medical conditions causing anxiety

A

CV (HF); endocrine (hyperthyroidism); neurologic (dementia, delirium); pulmonary (asthma, COPD)

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

Drug-induced anxiety

A
  1. Sympathomimetics: pseudoephedrine
  2. Stimulants: amphetamines, cocaine
  3. Theophylline, caffeine
  4. Thyroid hormone: levothyroxine
  5. CS: prednisolone
  6. Antidepressants
  7. Dopamine agonist: levodopa
  8. Beta-adrenergic agonists: salbutamol
  9. Drug withdrawal: caffeine, alcohol, sedatives, benzodiazepines, antidepressants, nicotine
  10. Drug intoxication: anticholinergics, antihistamines, digoxin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

define panic attack

A

discrete period of intense fear/discomfort that develop abruptly and reach a peak within 10mins (usually not longer than 20-30mins)

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

Gold standard assessment tool for anxiety in RCT

A

HAM-A

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

Non-pharm for anxiety

A

CBT (1st line esp for PTSD, combi with all meds)
Psychotherapy
Relaxation
Anxiety management
(OCD) Exposure and Responsive Prevention

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

Pharm tx for anxiety

A
  1. SSRI, SNRI (venlafaxine), clomipramine (TCA)
    (OCD: SSRI > clomipramine > SNRI)
  2. Pregabalin (for GAD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Adjunct tx for anxiety

A
  1. BZD (lorazepam, clonazepam, diazepam, alprazolam) short term PRN 1-2 weeks
  2. sedating antihistamine (hydroxyzine) for GAD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

approach to dosing for anxiety

A

start low go slow
- maintenance dose may be high end of the range (higher than depression dose)

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

onset and full response of serotonergic antidepressants for anxiety

A
  • Onset: at least 1-2mths
  • Full response: ~3mths (advise pt to be patient with tx)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

adjunct BZD is used in anxiety for…

A

for physical sx of anxiety (eg muscle tension), fast onset of action (within 30mins)

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

MOA of pregbalin

A

binding to alpha2-delta subunits at presynaptic voltage gated Ca channels → inhibits excitatory neurotransmission

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

why is lorazepam the safest?

A

does not undergo liver CL, does not accumulate during liver impairment

21
Q

DDI of benzodiazepines and antidepressants

A
  • Alcohol and other CNS depressants
  • Anticholinergic
  • MAOIs and SSRI/TCA combination
  • Benzodiazepines + opioids = increased mortality (CNS depression)
  • Most benzodiazepines are metabolised by CYP3A4 (except lorazepam)
22
Q

physiology of melatonin

A

melatonin secretion increased during sleep and is suppressed by bring light

23
Q

sleep promoting NT

A

GABA

24
Q

wakefulness promoting NT

A

NE, DA, acetylcholine, histamine, orexin

25
Q

most impt sleep period

A

NERM (non rapid eye movements) — stage 3 &4 = restorative/delta sleep

26
Q

normal adult need how many hours of sleep?

A

7hr

27
Q

Insomnia definition

A

inability to initiate/maintain sleep a/w daytime problems (fatigue, impaired concentration/ memory)

28
Q

Insomnia disorder

A

insomnia becomes a disorder if it impairs function: sleep complaint occurs ≥3 nights/week and present for ≥3mths

29
Q

Acute Transient insomnia (duration and mx)

A

<1 week
mx: sleep hygiene

30
Q

Acute Short term insomnia (duration and mx)

A

<4 weeks
mx: Sleep hygiene, short course PRN hypnotic (7-10days/ 1-2 weeks)

31
Q

Chronic insomnia (duration and mx)

A

> 4 weeks (≥3 nights/week)
mx: Investigate and manage underlying causes/ conditions, sleep hygiene
- Discourage long-term use of hypnotics

32
Q

Non-pharm for insomnia

A
  • CBT
  • Relaxation training
  • Sleep restriction therapy
  • Stimulus control therapy
  • Sleep hygiene
33
Q

Sleep hygiene eg

A
  1. Avoid caffeine, nicotine and alcohol esp later in the day
  2. Avoid heavy meals within 2 hrs of bedtime
  3. Avoid drinking fluids after dinner
  4. Avoid environments that will make you really active after 5pm
  5. Establish a routine for getting ready to go to bed
  6. Avoid taking daytime naps
  7. Pursue regular physical activities
34
Q

Indication of fast-acting anxiolytics/ sedatives/ hypnotics

A

ADJUNCT for SHORT-TERM RELIEF of distressful insomnia/anxiety
- PRN dosing at lowest effective dose and short course (1-2 weeks)

35
Q

Types of hypnotics (5)

A
  1. Benzodiazepines (Lorazepam, Diazepam)
  2. Z-hypnotics (zolpidem, zopiclone)
  3. Antihistamine (hydroxyzine, promethazine)
  4. melatonin
  5. lemborexant
36
Q

Zolpidem vs zopiclone

A

Zolpidem: shorter half life, less hangover, female half dose
Zopiclone: longer half life (preferred)

  • similar risk of dependence as BZD
37
Q

SE of BZD

A

sedation, drowsiness, muscle weakness, ataxia, amnesia
- minimise risk of dependence by taking short course 1-2 weeks PRN

38
Q

SE of Z-hypnotics (zolpidem, zopiclone)

A

complex sleep behaviours (sleep walking)
- zopiclone: taste disturbances

39
Q

SE of sedating antihistamine

A

anticholinergic SE (dry mouth, constipation, blurred vision)

40
Q

CI of promethazine

A

Promethazine not use for <2yo (cause death)

41
Q

MOA of lemborexant

A

orexin (OX1 and OX2) receptor antagonist

42
Q

SE of lemborexant

A

somnolence

43
Q

CI of lemborexant

A

narcolepsy (orexin deficiency - feels slpy during the day), moderate-strong CYP3A inhibitor/inducer, liver impairment

44
Q

off label drugs for insomnia

A
  • trazodone (antidepressants)
  • antipsychotics
45
Q

Benzodiazepines & Z-hypnotics should not be administered in

A
  1. acute narrow angle glaucoma
  2. respiratory depression
  3. myasthenia gravis
46
Q

Anticholinergics should be cautioned in

A

prostatic hypertrophy, urinary retention, angle closure glaucoma, epilepsy

47
Q

Additional precautions for Benzodiazepine use

A
  1. Hx of drug/alcohol abuse or psychiatric disorders (eg depression, psychosis)
  2. Prolonged usage (then abrupt discontinuation) should be avoided — need gradual dose tapering
  3. Benzodiazepines + opioids = increased mortality
48
Q

antihistamine used for anxiety vs insomnia

A

anxiety: hydroxyzine
insomnia: hydroxyzine, promethazine

53 Finals (10 decks)

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