Pharmacotherapy of Anxiety Flashcards
buspirone MOA
5HT-1a receptor agonist
what is buspirone used for
generalized anxiety
what is the buspirone dose in anxiety and how long will it take to work
10-15mg TID
may take up to 3-4 weeks for initial efficacy
how long should benzos be used for
short-term use
how and why to taper benzos
taper over weeks to months
acute withdrawal can lead to seizures
what are benzos on beer’s criteria for
fall risk, confusion, aggression
what are SEs of benzos
sedation
paradox excitement
swallowing issues
memory issues
overall impairment
what is hydroxyzine used for
generalized anxiety disorder
prn for insomnia or anxiety
who should avoid hydroxyzine
elderly due to anticholinergic side effects
what are the side effects of hydroxyzine
sedation
anticholinergic SEs
QTc prolongation
fall risk
what is propranolol used for
performance anxiety
how does propranolol work
decreases physiological symptoms of acute anxiety
what should be considered before starting propranolol
asthma and CV conditions
when to use gabapentinoids and quetiapine in anxiety
if patient has anxiety as well as bipolar or neuropathic pain
what are the warnings with Kava
may cause hepatotoxicity or liver failure
St. John’s P450
strong 3A4 inhibitor
when to avoid passionflower and valerian
pregnancy
when to avoid chamomile
ragweed allergy
what is first line for all anxiety disorders
SSRIs and SNRIs
buspirone
when can atypicals be used in anxiety
not for anxiety but can help in resistant OCD
when to use herbal therapies in anxiety
last line
what is the classification of GAD
excessive anxiety/worry for at least 6 months
what is 1st line for GAD
SSRIs and SNRIs (w/ pain syndromes)
when to use benzos in GAD
bridge therapy w/ SSRI/SNRI
when to use buspirone and hydroxyzine
adjunct and adjunct as needed for hydroxyzine
what is social anxiety
persistent fear about social/performance
specific situations may be avoided
lasts for at least 6 months
1st line treatment for social anxiety
SSRI
2nd line treatment for social anxiety
SNRIs
what is adjunct for social anxiety
propranolol for physical symptoms
what is panic disorder
recurrent attacks
abrupt surge of fear with physical symptoms
followed by anticipation of panic attack
1st line for panic disorder
SSRIs
2nd line for panic disorder
venlafaxine
adjunct for panic disorder
benzos
what is obsessive compulsive disorder
recurrent thoughts/images that are intrusive that are paired with repetitive behaviors/acts in response to obsession
1st line for OCD
SSRIs
2nd line for OCD
clomipramine
adjunct for OCD
risperidone and aripiprazole
what is Post Traumatic Stress Disorder (PTSD)
exposure to real or close death or forms of violence. includes flashbacks and reexperiencing
negative mood changes
1st for PTSD
SSRIs/SNRIs
what to use for sleep and nightmares with PTSD
prazosin
what is NOT recommended for PTSD
benzos
what is jitteriness syndrome and how to avoid it
use of SSRI/SNRI when treating anxiety
initial doses should be lowered
