L? pharmtx of anxiety - Ott Flashcards
6 drugs/classes that can cause anxiety
- albuterol ->jittery
- caffeine (high doses)
- decongestants (sudafed)
- levothyroxine -> jittery and amped up
- steroids
- stimulants -> ADHD meds
what is the MOA/class of buspirone (buspar)
serotonin (5HT-1a) receptor agonist
what is buspirone approved for use in? (only 1 thing)
GAD
target dose of buspirone
10-15mg tid
how long does it take for buspirone to reach initial efficacy?
3-4 weeks
T or F: Benzos have lower efficacy in some studies when compared to ssri’s in the treatment of anxiety disorders
False, they actually show better efficacy but are used less because of abuse potential
Acute withdrawal of benzos may lead to what
life-threatening seizures
there is a specific warning for the use of benzos with what other CNS depressant class?
opioids
T or F: Benzos without an active metabolite are less likely to accumulate, and have fall risk
True
Benzos with a long-acting active metabolite may lead to hangover and fall risk, especially in elderly
true
which 4 benzos do NOT have an active metabolite? **
alprazolam
lorazepam
clonazepam
oxazepam (tf is this one)
which 3 benzos DO have an active metabolite?
Diazepam
clorazepate
chlordiazepoxide
5 side effects of benzos *
- sedation
- paradoxical excitement (weird)
- swallowing difficulties
- impairment of memory and recall
- psychomotor impairment
T or F: D/C of benzos has a surprisingly fast taper period of days to weeks
false, slow taper weeks to months
which 3 benzos are appropriate in elderly pts
(LOT)
Lorazepam
Oxazepam
Temazepam
T or F: Hydroxyzine is FDA approved in GAD and PTSD
false, just GAD
Used most commonly “as needed” for anxiety or insomnia instead of a benzo
A. Buspirone
B. Propranolol
C. Hydroxyzine
C. Hydroxyzine
T or F: Hydroxyzine has a QTc prolongation risk
True
T or F: Hydroxyzine is safe to use in elderly due to its 5HT2a antagonizing effects
False, avoid use due to anticholinergic side effects and fall risk
Decrease physiological sxs of acute anxiety (tachycardia, sweating, flushing):
A. Buspirone
B. Propranolol
C. Hydroxyzine
B. Propranolol
useful for performance and situational anxiety:
A. Buspirone
B. Propranolol
C. Hydroxyzine
B. Propranolol
T or F: propranolol should be used in high doses for the tx of anxiety
false, low doses like 10-20 mg bid-tid
what should be evaluated/checked for before starting a pt on propranolol for anxiety? **
asthma and cardiovascular conditions
4 natural products ott mentioned in class for the tx of anxiety
st johns wort
passionflower
valerian
chamomile
in what cases what gabapentinoids be considered as anxiety tx?
pt with bipolar disorder + anxiety sxs
or
comorbid neuropathic pain
T or F: quetiapine has anxiolytic effects
False, the METABOLITE of it has anxiolytic effects
T or F: sleep medicine does not endorse the use of quetiapine for insomnia **
true (say this one outloud so it sticks)
what drug classes are 1st line for all anxiety disorders?
ssris and snris
Atypical antipsychotics are not fda approved for anxiety disorders but there has been clinical evidence for efficacy in what?
treatment-resistant OCD (abilify and risperidone)
How long does excessive anxiety/worry need to be present to be considered GAD?
at least 6 months
sxs of GAD include at least 3 of which 6 sxs?
restlessness
easily fatigued
difficulty concentrating
irritability
muscle tension
sleep disturbances
ssris take how long for initial onset of sxs relief in GAD?
2-4 weeks
SNRIs may be useful first line in what scenario? ***
if the pt also has a pain syndrome (use duloxetine) **
what drug class requires “bridge therapy” to cover time until the onset of an ssri/snri
benzos
Monitor for anticholinergic side effects in which of the following?
A. Buspirone
B. lorazepam
C. Duloxetine
D. Hydroxyzine
D. Hydroxyzine
duration of sxs for social anxiety disorder last at least how long
6 months (common theme here)
2 fda approved ssris for social anxiety **
paroxetine and sertraline *
which fda-approved SNRI may be useful if SSRI therapy fails for social anxiety? *
venlafaxine (so technically 2nd line)
what drug class may be useful in non-generalized performance related social anxiety?
beta blockers -> propranolol
an abrupt surge of intense fear or discomfort is called a what
panic attack
7 physical/psychological sxs of panic attacks (try your best)
- sweating
- palpitations
- nausea
- dizziness
- fear of losing control
- “going crazy” lol
- fear of dying
how many of the 7 physical/psychological sxs of panic attacks must be present to be considered a panic attack?
4/7
2nd line tx of panic disorder
SNRI-> venlafaxine
T or F: benzos could be considered 1st line for tx of panic disorder due to CNS depressant effects
false, only considered if there is an inadequate response to serotonergic drugs
what two benzos could be used for panic disorder
alprazolam and clonazepam
what percentage reduction can be expected for sx reduction in the tx of OCD after initial therapy
25-50% ***
if a pt with OCD fails multiple ssri’s what is the 2nd line treatment option? ***
Clomipramine (TCA)
T or F: Clomipramine is useful as 2nd line in OCD because of its low serotonergic effects
false, it is very serotonergic
what drug is useful in pts with PTSD that experience nightmares **
prazosin
T or F: benzos are recommended in PTSD
false, you dont wanna use them
T or F: polytherapy is common in PTSD
true, you want to target specific sxs
T or F: Pts with PTSD are less likely to partake in substance use
false, dipshit
Cognitive behavioral therapy and what may be helpful in the tx of PTSD ***
eye movement desensitization and reprocessing ***
what syndrome can result from the use of SSRIs and SNRIs when treating anxiety disorders **
“jitteriness” syndrome (she said this would be on the exam btw)
what two forms of therapy are “mainstays” of tx for anxiety disorders
psychotherapy and cognitive behavioral therapy
T or F: In PTSD, drug therapy may be more effective in combat trauma compared to civilian trauma
false, better use in civilian trauma
