Pharmacotherapy of Anxiety

Question 1

buspirone MOA

Answer 1

5HT-1a receptor agonist

Question 2

what is buspirone used for

Answer 2

generalized anxiety

Question 3

what is the buspirone dose in anxiety and how long will it take to work

Answer 3

10-15mg TID
may take up to 3-4 weeks for initial efficacy

Question 4

how long should benzos be used for

Answer 4

short-term use

Question 5

how and why to taper benzos

Answer 5

taper over weeks to months
acute withdrawal can lead to seizures

Question 6

what are benzos on beer’s criteria for

Answer 6

fall risk, confusion, aggression

Question 7

what are SEs of benzos

Answer 7

sedation
paradox excitement
swallowing issues
memory issues
overall impairment

Question 8

what is hydroxyzine used for

Answer 8

generalized anxiety disorder
prn for insomnia or anxiety

Question 9

who should avoid hydroxyzine

Answer 9

elderly due to anticholinergic side effects

Question 10

what are the side effects of hydroxyzine

Answer 10

sedation
anticholinergic SEs
QTc prolongation
fall risk

Question 11

what is propranolol used for

Answer 11

performance anxiety

Question 12

how does propranolol work

Answer 12

decreases physiological symptoms of acute anxiety

Question 13

what should be considered before starting propranolol

Answer 13

asthma and CV conditions

Question 14

when to use gabapentinoids and quetiapine in anxiety

Answer 14

if patient has anxiety as well as bipolar or neuropathic pain

Question 15

what are the warnings with Kava

Answer 15

may cause hepatotoxicity or liver failure

Question 16

St. John’s P450

Answer 16

strong 3A4 inhibitor

Question 17

when to avoid passionflower and valerian

Answer 17

pregnancy

Question 18

when to avoid chamomile

Answer 18

ragweed allergy

Question 19

what is first line for all anxiety disorders

Answer 19

SSRIs and SNRIs
buspirone

Question 20

when can atypicals be used in anxiety

Answer 20

not for anxiety but can help in resistant OCD

Question 21

when to use herbal therapies in anxiety

Answer 21

last line

Question 22

what is the classification of GAD

Answer 22

excessive anxiety/worry for at least 6 months

Question 23

what is 1st line for GAD

Answer 23

SSRIs and SNRIs (w/ pain syndromes)

Question 24

when to use benzos in GAD

Answer 24

bridge therapy w/ SSRI/SNRI

Question 25

when to use buspirone and hydroxyzine

Answer 25

adjunct and adjunct as needed for hydroxyzine

Question 26

what is social anxiety

Answer 26

persistent fear about social/performance
specific situations may be avoided
lasts for at least 6 months

Question 27

1st line treatment for social anxiety

Answer 27

SSRI

Question 28

2nd line treatment for social anxiety

Answer 28

SNRIs

Question 29

what is adjunct for social anxiety

Answer 29

propranolol for physical symptoms

Question 30

what is panic disorder

Answer 30

recurrent attacks
abrupt surge of fear with physical symptoms
followed by anticipation of panic attack

Question 31

1st line for panic disorder

Answer 31

SSRIs

Question 32

2nd line for panic disorder

Answer 32

venlafaxine

Question 33

adjunct for panic disorder

Answer 33

benzos

Question 34

what is obsessive compulsive disorder

Answer 34

recurrent thoughts/images that are intrusive that are paired with repetitive behaviors/acts in response to obsession

Question 35

1st line for OCD

Answer 35

SSRIs

Question 36

2nd line for OCD

Answer 36

clomipramine

Question 37

adjunct for OCD

Answer 37

risperidone and aripiprazole

Question 38

what is Post Traumatic Stress Disorder (PTSD)

Answer 38

exposure to real or close death or forms of violence. includes flashbacks and reexperiencing
negative mood changes

Question 39

1st for PTSD

Answer 39

SSRIs/SNRIs

Question 40

what to use for sleep and nightmares with PTSD

Answer 40

prazosin

Question 41

what is NOT recommended for PTSD

Answer 41

benzos

Question 42

what is jitteriness syndrome and how to avoid it

Answer 42

use of SSRI/SNRI when treating anxiety
initial doses should be lowered