Week 13 - Anxiolytics and Hypnotics

Question 1

True/False: The majority of medications that are prescribed for anxiety disorders are antidepressants

Answer 1

True - d/t lack of dependency

Question 2

What medication can be used for occassional severe anxiety attacks?

Answer 2

Benzodiazepines

Question 3

What are the three primary neural pathways involved in anxiety?

Answer 3

5-HT, norepinephrine, and GABA

Question 4

Which classification of medications would be prescribed for phobic states and panic disorder?

Answer 4

Evidence is showing superiority of SSRIs and clomipramine (Anafranil) over benzodiazepines

Busprione (BuSpar) has been suggested as an additive medication

Question 5

Which medications have shown evidence for remission of symptoms in GAD?

Answer 5

• Escitalopram
• Paroxetine
• Sertraline

Question 6

Which medications have shown evidence for reduction of symptoms in GAD?

Answer 6

• Duloxetine
• Venlafaxine
• Trazodone
• Citalopram

Question 7

Standard approach for treatment of OCD

Answer 7

Start w/ SSRI or clomipramine, then move to other pharmacological strategies if the serotonin-specific drugs are not effective

Combination of a medication + CBT is most effective

Question 8

True/False: CBT monotherapy may be less effective than monotherapy w/ SSRIs in children and adolescents

Answer 8

False - more effective

Question 9

FDA approved medications for PTSD

Answer 9

Sertraline (Zoloft) and paroxetine (Paxil)

Question 10

VA/DoD Clinical Practice Guidelines medication recommendations to treat PTSD

Answer 10

Venlafaxine (Effexor) and fluoxetine (Prozac)

Question 11

True/False: SSRIs/SNRIs reduce symptoms from all PTSD symptom clusters (re-experiencing, avoidance, hyperarousal)

Answer 11

True

Question 12

Which medication would be prescribed to treat PTSD w/ nightmares?

Answer 12

Prazosin (Minipress)

• Blocks some of the effects of adrenaline
• Blocks noradrenergic stimulation of alpha-1 receptor

Question 13

True/False: Buspirone (BuSpar) is similar to benzodiazepines in anxiolytic effect

Answer 13

True

Question 14

Buspirone (BuSpar): patient education

Answer 14

• No physical dependence, withdrawal, abuse potential
• Less sedation and psychomotor impairment
• Lack of interaction w/ alcohol
• Slow onset of action (1-2 weeks)

Question 15

Barbiturates (phenobarbital): patient education

Answer 15

• High abuse and addiction potential
• Narrow TI

Question 16

Can clonidine be used to treat anxiety disorders (including PTSD)?

Answer 16

Yes - also FDA approved for HTN and ADHD

Centrally acting alpha-2 agonist

Question 17

Can propanolol (Inderal) be used to treat anxiety and PTSD?

Answer 17

Yes - also used to treat violence/aggressive behavior

PTSD: blockade of beta-1 adrenergic receptors can prevent fear conditioning and reconsolidation of fear

Violence/aggression: poorly established, may have central actions at beta adrenergic and serotonin receptors