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Therapeutics IV > Manage ANXIETY > Flashcards

Manage ANXIETY Flashcards

1
Q

Definition of GAD

A

Excessive anxiety and worries >6 months

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2
Q

Main Biological mechanism of anxiety disorders

A

Neurochemical deregulation such as:

  • NE increased in locus coeruleus of brain
  • 5HT, GABA, and others
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3
Q

Distinguish between the five different type of anxiety disorders

A
  1. GAD: Excessive anxiety and worry for ≥ 6months,
  2. PD: RECURRENT, UNEXPECTED panic attacks
  3. SAD: Fear/anxiety or avoidance of social/perf situation ≥6 months. Person fears humiliation/embarrassment in their act
  4. OCD: Recurrent and persistent thoughts/actions that are intrusive
  5. PTSD: Exposure to traumatic events with involuntary thoughts after occurrence for ≥1 month
    - ASD: same as PTSD, but 3d-1month after trauma

POP-SG

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4
Q

Goals and Duration of therapy in Anxiety disorder

A

Goals:

  1. Remission of sx
  2. Return to pre-morbid functioning

Duration: ≥1 year, some may need lifelong tx

(note: OCD: 1-2y tx)

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5
Q

Common first line pharmaco therapy among ALL anxiety disorders

A

SSRI

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6
Q

First line options for all the different anxiety disorders (aside from SSRI)

A
  1. GAD: SNRI, Pregabalin
  2. PD: Venlafaxine
  3. SAD: Venlafaxine
  4. OCD: NIL (only ssri)
  5. PTSD: SNRI
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7
Q

Second line options for all the different anxiety disorders

A
  1. GAD: Mirtazapine, Imipramine
  2. PD: Clomi, Imi (TCA)
  3. SAD: Moclobemide (MAOI)
  4. OCD: Clomipramine (TCA)
  5. PTSD: Mirtazapine
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8
Q

What if patients fail first-line Pco tx for anxiety disorders?

A

Refer to specialist for further assessment and management

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9
Q

State the most common non-pco tx for anxiety disorders

A

CBT (Cognitive behavioural therapy)

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10
Q

Name the non-pco tx unique to SAD

A

Social skills training

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11
Q

Name the non-pco tx unique to OCD

A

DBT (Dialectical Behavioural Therapy)

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12
Q

List the non-pco txs unique to PTSD

A
  1. Exposure therapy

2. Eye movement desensitisation and reprocessing (EMDR)

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13
Q

What is expected in patients who are only initiated with ADs (antidepressants) for anxiety disorders? Are there any ways to help with this?

A

Transient jitteriness in first 1-2 weeks

  • Adjunct BZD PRN
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14
Q

General rule for dosing ADs in anxiety

A

Start low, go slow, titrate up

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15
Q

What are some differences between the usage of ADs in anxiety VS ADs in depression?

A
  1. Anxiety: Higher range of maintenance dose (E.g. prozac 60-80mg for anxiety instead of 20-60mg for depression)
  2. Anxiety: ADs usually take 3 months for full response (instead of 1 month for depression)
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16
Q

Onset of different therapeutic effects of ADs in anxiety disorders

A
  1. Early anxiolytic effect: 2-4 weeks
  2. Improvements: 4-6 weeks
  3. Full response: up to 3 months
17
Q

BZD are indicated for the short-term relief of severe anxiety EXCEPT which anxiety disorder?

A

PTSD

18
Q

Purpose of BZD in anxiety?

A

Short-term relief of SEVERE anxiety, useful for the PHYSICAL sx

19
Q

Caution with use of BZD?

A

Use short term to reduce risk of dependence

20
Q

How to minimise risk of BZD misuse, dependence and withdrawal?

A
  1. Taper dose
    - 25% per week till half of original dose
    - Then 1/8 every 4-7d
    OR
  2. Switch to LONGER HALF-LIFE BZD (diazepam) at EQUIVALENT daily dose, then taper gradually
    AND
  3. Avoid Rx BZD to patients with co-morbid alc/substance abuse
21
Q

What are some other Tx options and their purpose in Anxiety disorders?

A
  1. Pregabalin: GAD. Rq renal adjustment CrCL < 60
  2. Buspirone: ONLY FOR GAD. Delayed onset (2 wk)
  3. Hydroxyzine: Anxiolytic from its sedative properties (tolerance in 2 weeks)
  4. Propranolol: taken BEFORE anxiety-provoking situation
  5. SGA: used by specialists as augmentation
22
Q

Name the main drug interactions of BZD and ADs in terms of CYP enzymes

A
  1. BZD: 3A4 (except lorazepam)

2. ADs: 2D6, 3A4

23
Q

Presentation of serotonin syndrome and how to avoid?

A

Presents as clinical TRIAD:

  1. Mental status changes
  2. Autonomic hyperactivity
  3. Neuromuscular abnormalities

To avoid: Avoid multiple HT-agents/buspirone with MAOI

24
Q

Monitoring parameters for Anxiety?

A
  1. Sx diary:
    - E.g. characteristics of anxiety episodes, any suicidal/homicidal thoughts, frequency, duration, triggers, etc.
  2. ADR of pharmacotherapy
    - E.g. Insomnia/Drowsiness from ADs
    - E.g. Ataxia in BZD
    - E.g. suicide in ≤24yo on ADs
25
Q

What class of drugs must be avoided with BZD?

A

Opioids: Cause fatal CNS depression

Therapeutics IV (9 decks)

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