Treatment of Anxiety Disorder Flashcards
What is the “alarm center” for anxiety that causes the symptoms (noradrenergic transmission)
Locus coeruleus
How does serotonin effect anxiety
Serotonin in the amygdala turns on GABA, which turns off glutamate
T/F: SSRI, SNRI and bupropion can be used to treat anxiety but does can increase anxiety initially before decreasing it
True
What are the drugs associated with anxiety symptoms upon withdrawl
Barbiturates, benzodiazepines, ethanol, narcotics
What is generalized anxiety disorder
ongoing state of excessive WORRY or anxiety lacking any clear reason
What is the cardinal symptom of generalized anxiety disorder, how long must it last to be considered GAD
Excessive anxiety/worry with difficulty controlling worry, over 6 months
What is the symptom of panic disorder
Discrete (short/abrupt) episode of sudden attack of overwhelming fear or terror (impending doom) with the cause not known (recurrent UNexpected attacks at least once a month)
What is the symptoms of Obsessive-compulsive disorder (OCD)
obsessive or intrusive thoughts causing marked anxiety and distress, compulsions are ritualistic and repetitive
What is Posttraumatic stress disorder
Anxiety triggered by the insistent recall of past stressful experiences
T/F: Social anxiety disorder is marked by fear of being embarrassed
True
What are non-pharmacological treatments of anxiety disorder
Education, Cognitive behavioral Therapy ( can prevent relapse)
What are the first line drug class for anxiety disorders
Antidepressants: SSRIs, SNRIs, TCAs and MAOI (limited use)
T/F: SSRIs and bupropion can be used to treat all the anxiety disorders discussed
False: Bupropion CAN NOT be used for panic disorder but SSRIs is effecitve for all the other anxiety disorders
What is the best way to potentially avoid transient increases in anxiety when starting an SSRI
Initiate at the lowest available dose (half antidepressant doses)
Which patients should especially receive antidepressants for their anxiety
Patient has a history of substance abuse or concurrent depression
What is MOA of BZD
Increase the frequency of GABA-Cl channels in RESPONSE to GABA stimulation
What is the place of therapy for anxiety
Can give short term to mitigate transient depression when using SSRIs
T/F: BZDs are more effective than SSRIs in treating cognitive symptoms and less effective in treating somatic symptoms
False: BZDs are LESS effective than SSRIs in treating COGNITIVE symptoms and MORE effective in treating SOMATIC symtptoms
Which anxiety disorder population are BZDs contraindicated
PTSD
T/F: BDZs can interfere with CBT treatment for OCD
True
What are the adverse effects of BZDs
Sedation/drowsiness, ataxia, visual-spatial impairment, anetograde amnesia
What is the antidote for BZDs overdose
Flumazenil
T/F: BZDs can be taking with alcohol but at low amounts only
False: BZDs should NEVER be used with alcohol
When using BZDs what aspects do patients become intolerant of, where is the no intolerant
Sedation and euphoria, anxiolytic effects
T/F: Relapse and rebound are common when using BZDs but must taper down so that seizures and other symptoms are less likely to occur
True
What anxiety disorder is buspione approved for
GAD
What is is the major drawback of buspirone use for anxiety
2-4 weeks for therapeutic effects
What can be used for anxiety symptoms such as fast heart rate
Beta-blockers
What drug can be use as needed for anxiety and is FDA approved
Hydroxyzine (H1 antagonist)
What is the first line for GAD,Panic disorder
CBT and SSRI and SNRI, SSRIs and venlafaxine
T/F: BZDs can’t be used for panic disorder as needed
True
What can be used to treat OCD, what type of dosing, how long
SSRIs and clomipramine (if SSRI ineffective), higher dose than for depression, at least 10-12 weeks
T/F: Medications are more effective than CBT for treating OCD
False: CBT appears to be more effective than medications for treating OCD
What anxiety disorders can BZDs never be used in, only time it can be used PRN
OCD, PTSD, social anxiety
What lipophilic alpha-blocker can be used to elevate nightmares in someone who has nightmares due to their PTSD
Prazosin
