Pharm Test 3 Anxiety

Question 1

Panic Disorder

Answer 1

DOC: SSRI
Benzo are not preferred for long term tx but may be used when pt’s fail several antidepressant trials
**TCA and MAO-I may be effective when an SSRI is not
**Alprazolam may cause rebound anxiety b/w doses and has been associated with a withdrawal syndrome including seizures

Question 2

Social Anxiety Disorder

Answer 2

DOC: SSRI

Onset 8-12 weeks

Question 3

OCD

Answer 3

Clomipramine, fluoxetine, fluvoxamine, paroxetine and sertraline all approved

• for highly anxious pts–> add benzo or antipsychotic
• *No differencein efficacy b/w clomipramine and SSRI but SSRI have a better side effect profile

Question 4

PTSD

Answer 4

DOC: SSRI. Sertraline is approved for long term management

**Other antidepressants (venlafaxine, MAO-I, TCA) can also be effective but have less favorable side effect profiles

Question 5

Performance anxiety

Answer 5

Propranolol or other Beta blocker are DOC

Question 6

Genreal Anxiety Disorder

Answer 6

DOC: Antidepressants
-Venlafaxine and SSRI’s are preferred (safety and tolerability)
-Replaced benzo’s due to better AE profile, no risk for dependency and efficacy is common in comorbid conditions (PD, OCD, SAD, depression)
Buspirone (2nd line): no abuse potential or withdrawal rxn; doesn’t potentiate alcohol or sedative hypnotic effects, onset 2-4 weeks.

• **Reduce the psychotic sxs witha modest effect on autonomic and somatic sxs. Benzo can be used for acute tx, as an adjuvant during initiatoin of antidepressant therapy or to improve sleep.
• *Other alt: hydroxyzine, pregabalin