Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

7453 Neurology > S54 - Pharmacology of Anxiety Disorders > Flashcards

S54 - Pharmacology of Anxiety Disorders Flashcards

1
Q

_____________ are the most effective and safe (relatively) for rapid relief of anxiety symptoms.

A

Benzodiazepines

BZD's
clobazam (Onfi®)
clonazepam (Klonopin®)
clorazepate (Tranxene®)
diazepam (Valium®)
lorazepam (Ativan®)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

_________ is an optional treatment in patients without comorbid depression or other anxiety disorders.

A

Buspirone (Buspar)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

First Line therapy for Generalized Anxiethy Disorder (GAD)

A 
Duloxetine (Cymbalta)
Escitalopram (Lexapro)
Paroxetine (Paxil)
Sertraline (Zoloft)
Venlafexine XR (Effexor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

First Line therapy for Panic Disorder

A

SSRI’s

  • fluoxetine (Prozac)
  • sertraline (Zoloft)
  • paroxetine (Paxil)
  • citalopram (Celexa)
  • escitalopram (Lexapro)
  • vortioxetine (Trintellix)

Venlafexine XR (Effexor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

First Line Therapy for Social Anxiety Disorder

A 
Escitalopram (Lexapro)
Paroxetine (Paxil)
Sertraline (Zoloft)
Venlafexine XR (Effexor)
Fluvoxemine CR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Aytpical antipsychotics low-dose have been used for GAD –

A

Quetiapine 150 mg = paroxetine 20 mg/day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pregabalin is used in Europe as a first-line agent for GAD.

A

Off-label at best in the USA.

Not included into treatment algorithms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Antidepressants are considered the first-line agents in GAD.

A 
Duloxetine (Cymbalta)
Escitalopram (Lexapro)
Paroxetine (Paxil)
Sertraline (Zoloft)
Venlafexine XR (Effexor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

FDA approved for Generalized Anxiety Disorder (GAD)

Response is delayed 2-4 weeks.

A

paroxetine (Paxil)
duloxetine (Cymbalta)
venlafaxine (Effexor)
escitalopram (Lexapro)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

________ is FDA approved for PD with or without agoraphobia.

A

Alprazolam (Xanax)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

FDA Approved agents for acute anxiety

A 
Alprazolam (Xanax)
clonazepam (Klonopin®)
clorazepate (Tranxene®)
diazepam (Valium®)
lorazepam (Ativan®)
chlordiazepoxide (Librium)
Oxazepam (Serax)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

IM administration of diazepam and chlordiazepoxide should be AVOIDED –

A

erratic absorption and painful.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which BZD’s are glucuronidated?

A

Only lorazepam and oxazepam are glucuronidated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clonazepam undergoes

A

nitroreduction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Diazepam is also metabolized by

A

CYP 2C19

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

__________ is a prodrug converted to DMDZ in the GI tract under acidic pH. Watch out for antacid use!

A

Clorazepate

Long-acting BZ are metabolized to desmethyldiazepam (DMDZ) – active metabolite.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

BZ efficacy – 65-75% response rate within 2 weeks.

Only effective for the

A

somatic symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Unique to benzodiazepines where patient can become highly agitated and increased BZD’s increases agitation.

A

Disinhibition syndrome

19
Q

_________ _________ – rebound anxiety with Increased symptoms greater than baseline.

A

Benzodiazepine discontinuation

20
Q

BZD’s have drug interactions with:

A

CYP3A4 inhibitors (ketoconazole) and inducers (carbamazepine).

21
Q

__________ – nonBZ without anticonvulsant, hypnotic, motor impairment or dependence .

A

Buspirone (Buspar)

2nd line agent for GAD.
Delayed onset > 2 weeks.

MOA: 5-HT1A partial agonist activity at presymaptic neurons ↓ firing of 5-HT neurons.

Do not use with MAOI’s for concern of serotonin syndrome.

22
Q

Pregnancy avoids

A

Antidepressants (SSRI’s and TCA’s) are preferred agents for pregnant pts. except paroxetine.

Benzodiazepines (BZs) associated with cleft lip and cleft palate in babies.

Clinicians avoid BZs during the 1st trimester.

BZs use in the 3rd trimester: sedation, withdrawal and “floppy baby syndrome.”

Alprazolam and lorazepam reported to cause neonatal withdrawal symptoms.

23
Q

Panic Disorder (PND)

A

SSRI’s are considered first-line due to safety and tolerability.

Combination of psychotherapy and drug therapy.

CBT is used 16-20 hrs over 4 months

24
Q

Panic Disorder (PND) treatment duration

A

Acute phase TX. : 1-3 months, therapy altered if no response found 6-8 weeks.
Maintenance Tx. : 12-24 months, drug dc’d over 4-6 months.
Monitor for various issues – BZ dependence, SSRI withdrawal syndrome and etc

25
Q

FDA Approved for Generalized Anxiety Disorder

A 
Sertraline (Zoloft)
Paroxetine (Paxil)
Escitalopram (Lexapro)
Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Buspirone (Buspar)
26
Q

FDA Approved for Social Anxiety Disorder

A

Sertraline (Zoloft)
Paroxetine (Paxil)
Fluvoxamine
Venlafaxine (Effexor)

27
Q

FDA Approved for Panic Disorder

A

Sertraline (Zoloft)
Paroxetine (Paxil)
Clonazepam (Klonopin)
Alprazolam (Xanax)

28
Q

Special populations: SAD present in young children.

A

Monitored closely for suicidal ideation when SSRI or SNRI is used.
BZs’ last line of agents for children with SAD.
1/5 pts. also have alcohol use.
Do not use MOAI’s.
Careful use of BZs.

29
Q

SNRI’s: effective for pts. Who do not respond to SSRI’s.

Use like for depressed pts.

A

Mirtazapine 30 mg/day was used in women over 10 weeks.
BZ’s: reserve use for pts. who can not use SNRI’s or SSRI’s.
Gabapentin was reported to be effective.
beta-blockers were found not be effective for daily use.

30
Q

__________ were developed for treatment of anxiety disorders, but are 2nd line agents after SSRIs/SNRIs

A

Benzodiazepines

31
Q

Are the benzodiazepines considered the “first-line” agent for GAD treatment?

A

NO… SSRIs/SNRIs

32
Q

Can benzodiazepines be abruptly discontinued?

A

NO… withdrawal symptoms can occur

33
Q

What is the minimum amount of time needed for treatment with a SSRI for patient with PND who responses to a SSRI agent?

A

Minimum 12 mons/ can be up to 24 mos.

34
Q

BZ’s: alprazolam is the ideal agent who need rapid relief (1-2 weeks). Relapse rates 50% or higher.

A

True

35
Q

SNRI’s was reported to be effective 54-60% respond.

A

True

36
Q

SAD: When drug were dc’d after 2-3 months, relapse > than 5-12 months.

A

True

37
Q

SSRI’s and SNRI’s are equally effective.

TCA’s are not effective in SAD.

A

True

38
Q 
SAD Start with:
 - fluoxetine (Prozac)
- sertraline (Zoloft)
- paroxetine (Paxil)
- citalopram (Celexa)
- escitalopram (Lexapro)
- vortioxetine (Trintellix) or
 venlafexine for 12 weeks
A

True

39
Q 
SAD Start with:
 - fluoxetine (Prozac)
- sertraline (Zoloft)
- paroxetine (Paxil)
- citalopram (Celexa)
- escitalopram (Lexapro)
- vortioxetine (Trintellix) or
 venlafexine for 12 weeks

IF RESPONSE

A

Continue for 12 weeks

40
Q 
SAD Start with:
 - fluoxetine (Prozac)
- sertraline (Zoloft)
- paroxetine (Paxil)
- citalopram (Celexa)
- escitalopram (Lexapro)
- vortioxetine (Trintellix) or
 venlafexine for 12 weeks

IF NO RESPONSE

A

SWITCH SSRI or if not used venlafexine use that

41
Q 
SAD Start with:
 - fluoxetine (Prozac)
- sertraline (Zoloft)
- paroxetine (Paxil)
- citalopram (Celexa)
- escitalopram (Lexapro)
- vortioxetine (Trintellix) or
 venlafexine for 12 weeks

if PARTIAL response

A

Augment with Buspar or clonazepam

42
Q

SNRI’s: effective for pts. Who do not respond to SSRI’s

A

True

43
Q

Mirtazapine 30 mg/day was used in women over 10 weeks.

A

True

7453 Neurology (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions