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PHRM 845 > L? pharmtx of anxiety - Ott > Flashcards

L? pharmtx of anxiety - Ott Flashcards

1
Q

6 drugs/classes that can cause anxiety

A
  • albuterol ->jittery
  • caffeine (high doses)
  • decongestants (sudafed)
  • levothyroxine -> jittery and amped up
  • steroids
  • stimulants -> ADHD meds
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2
Q

what is the MOA/class of buspirone (buspar)

A

serotonin (5HT-1a) receptor agonist

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3
Q

what is buspirone approved for use in? (only 1 thing)

A

GAD

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4
Q

target dose of buspirone

A

10-15mg tid

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5
Q

how long does it take for buspirone to reach initial efficacy?

A

3-4 weeks

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6
Q

T or F: Benzos have lower efficacy in some studies when compared to ssri’s in the treatment of anxiety disorders

A

False, they actually show better efficacy but are used less because of abuse potential

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7
Q

Acute withdrawal of benzos may lead to what

A

life-threatening seizures

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8
Q

there is a specific warning for the use of benzos with what other CNS depressant class?

A

opioids

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9
Q

T or F: Benzos without an active metabolite are less likely to accumulate, and have fall risk

A

True

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10
Q

Benzos with a long-acting active metabolite may lead to hangover and fall risk, especially in elderly

A

true

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11
Q

which 4 benzos do NOT have an active metabolite? **

A

alprazolam
lorazepam
clonazepam
oxazepam (tf is this one)

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12
Q

which 3 benzos DO have an active metabolite?

A

Diazepam
clorazepate
chlordiazepoxide

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13
Q

5 side effects of benzos *

A
  • sedation
  • paradoxical excitement (weird)
  • swallowing difficulties
  • impairment of memory and recall
  • psychomotor impairment
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14
Q

T or F: D/C of benzos has a surprisingly fast taper period of days to weeks

A

false, slow taper weeks to months

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15
Q

which 3 benzos are appropriate in elderly pts

A

(LOT)
Lorazepam
Oxazepam
Temazepam

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16
Q

T or F: Hydroxyzine is FDA approved in GAD and PTSD

A

false, just GAD

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17
Q

Used most commonly “as needed” for anxiety or insomnia instead of a benzo
A. Buspirone
B. Propranolol
C. Hydroxyzine

A

C. Hydroxyzine

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18
Q

T or F: Hydroxyzine has a QTc prolongation risk

A

True

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19
Q

T or F: Hydroxyzine is safe to use in elderly due to its 5HT2a antagonizing effects

A

False, avoid use due to anticholinergic side effects and fall risk

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20
Q

Decrease physiological sxs of acute anxiety (tachycardia, sweating, flushing):
A. Buspirone
B. Propranolol
C. Hydroxyzine

A

B. Propranolol

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21
Q

useful for performance and situational anxiety:
A. Buspirone
B. Propranolol
C. Hydroxyzine

A

B. Propranolol

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22
Q

T or F: propranolol should be used in high doses for the tx of anxiety

A

false, low doses like 10-20 mg bid-tid

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23
Q

what should be evaluated/checked for before starting a pt on propranolol for anxiety? **

A

asthma and cardiovascular conditions

24
Q

4 natural products ott mentioned in class for the tx of anxiety

A

st johns wort
passionflower
valerian
chamomile

25
Q

in what cases what gabapentinoids be considered as anxiety tx?

A

pt with bipolar disorder + anxiety sxs
or
comorbid neuropathic pain

26
Q

T or F: quetiapine has anxiolytic effects

A

False, the METABOLITE of it has anxiolytic effects

27
Q

T or F: sleep medicine does not endorse the use of quetiapine for insomnia **

A

true (say this one outloud so it sticks)

28
Q

what drug classes are 1st line for all anxiety disorders?

A

ssris and snris

29
Q

Atypical antipsychotics are not fda approved for anxiety disorders but there has been clinical evidence for efficacy in what?

A

treatment-resistant OCD (abilify and risperidone)

30
Q

How long does excessive anxiety/worry need to be present to be considered GAD?

A

at least 6 months

31
Q

sxs of GAD include at least 3 of which 6 sxs?

A

restlessness
easily fatigued
difficulty concentrating
irritability
muscle tension
sleep disturbances

32
Q

ssris take how long for initial onset of sxs relief in GAD?

A

2-4 weeks

33
Q

SNRIs may be useful first line in what scenario? ***

A

if the pt also has a pain syndrome (use duloxetine) **

34
Q

what drug class requires “bridge therapy” to cover time until the onset of an ssri/snri

A

benzos

35
Q

Monitor for anticholinergic side effects in which of the following?
A. Buspirone
B. lorazepam
C. Duloxetine
D. Hydroxyzine

A

D. Hydroxyzine

36
Q

duration of sxs for social anxiety disorder last at least how long

A

6 months (common theme here)

37
Q

2 fda approved ssris for social anxiety **

A

paroxetine and sertraline *

38
Q

which fda-approved SNRI may be useful if SSRI therapy fails for social anxiety? *

A

venlafaxine (so technically 2nd line)

39
Q

what drug class may be useful in non-generalized performance related social anxiety?

A

beta blockers -> propranolol

40
Q

an abrupt surge of intense fear or discomfort is called a what

A

panic attack

41
Q

7 physical/psychological sxs of panic attacks (try your best)

A
  • sweating
  • palpitations
  • nausea
  • dizziness
  • fear of losing control
  • “going crazy” lol
  • fear of dying
42
Q

how many of the 7 physical/psychological sxs of panic attacks must be present to be considered a panic attack?

A

4/7

43
Q

2nd line tx of panic disorder

A

SNRI-> venlafaxine

44
Q

T or F: benzos could be considered 1st line for tx of panic disorder due to CNS depressant effects

A

false, only considered if there is an inadequate response to serotonergic drugs

45
Q

what two benzos could be used for panic disorder

A

alprazolam and clonazepam

46
Q

what percentage reduction can be expected for sx reduction in the tx of OCD after initial therapy

A

25-50% ***

47
Q

if a pt with OCD fails multiple ssri’s what is the 2nd line treatment option? ***

A

Clomipramine (TCA)

48
Q

T or F: Clomipramine is useful as 2nd line in OCD because of its low serotonergic effects

A

false, it is very serotonergic

49
Q

what drug is useful in pts with PTSD that experience nightmares **

A

prazosin

50
Q

T or F: benzos are recommended in PTSD

A

false, you dont wanna use them

51
Q

T or F: polytherapy is common in PTSD

A

true, you want to target specific sxs

52
Q

T or F: Pts with PTSD are less likely to partake in substance use

A

false, dipshit

53
Q

Cognitive behavioral therapy and what may be helpful in the tx of PTSD ***

A

eye movement desensitization and reprocessing ***

54
Q

what syndrome can result from the use of SSRIs and SNRIs when treating anxiety disorders **

A

“jitteriness” syndrome (she said this would be on the exam btw)

55
Q

what two forms of therapy are “mainstays” of tx for anxiety disorders

A

psychotherapy and cognitive behavioral therapy

56
Q

T or F: In PTSD, drug therapy may be more effective in combat trauma compared to civilian trauma

A

false, better use in civilian trauma

PHRM 845 (34 decks)

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