Pharm - Anxiety Disorders Flashcards
Anxiety has to be present for how long for GAD diagnosis?
6 months or more
How do Benzodiazepines work?
Increase the frequency of the GABA channel opening.
When the GABA channel is open, it inhibits a cell’s ability to fire
Benzodiazepines have 5 properties - what are they?
Anxiolytics Hypnotic Muscle relaxant Anticonvulsant Amnesiac
How long do benzos last?
There are two different kinds:
Short half-life, which are high potency (best for acute management)
Long half-life, which are low potency (best for ETOH withdrawal?)
What are the disadvantages of low-potency/long half-life benzos?
More “hangover” symptoms in the morning
Accumulation in the elderly
Which are the most commonly used BZDs for anxiety (5)?
Alprazolam (Xanax) Clonazepam (Klonipin) Diazepam (Valium) Lorazepam (Ativan) Chlordiazepoxide (Librium)
What is the recommended treatment time for benzodiazepines? Can you stop abruptly? Why?
3-4 weeks.
Must taper off b/c physiological dependence can occur in weeks-months.
Which are the agents of choice for long-term anxiety treatment? Examples? What should we know about starting treatment?
SSRIs
- Venlafaxine (GAD and social anxiety)
- Duloxetine (GAD)
TCAs: preventative for panic disorder
Can have a paradoxical response at initiation. Start low go slow.
Buspirone: pros/cons
No abuse potential
Not everyone agrees that it works on GAD (no evidence for other anxiety disorders).
Takes a long time to work (weeks). Bridge therapy with bzds might happen.
Common drug therapies for GAD?
First line: SSRIs, SNRIs, Imipramine
BZDs, but shouldn’t use long-term
Buspirone, but takes a little while.
Drugs of choice for therapy for panic disorder?
First-line: SSRIs, SNRIs. Start low, go slow.
Benzos.
Also use CBT!
Common treatments for social anxiety disorder?
CBT should be the go-to.
First line meds: SSRIs, Venlafaxine.
Clonazepam: adjunct therapy
Sometimes gabapentin and pregabalin.
Common drug therapies for OCD?
Higher doses of SSRIs, Clomipramine
Augmentation with haloperidol or an SGA
Common treatments for PTSD?
Psychotherapy = cornerstone!
Medication: adjuncts to therapy. First-line: SSRIs Anticonvulsants for aggression, anger, depression SGAs for psychotic symptoms BZDs for sleep (but limit use)
