Anxiety

Question 1

Non-Pharmacologic Treatments

Answer 1

Used alone or in combo
Supportive Therapy
CBT
Biofeedback
Relaxation

Question 2

1st line

Answer 2

SSRI/SNRI
or Non-benzo/non-barbituates: Busipirone
2nd line: Benzos

Question 3

Fluvoxamine

Answer 3

IND: OCD, Social Anxiety Disorder
MOA: SSRI
BOX: Anti-depressants
CON: MAOIs
ADR: CNS, Sexual dysfunction, N/D

Question 4

Buspirone

Answer 4

IND: GAD
MOA: 5HT1A and 5HT2 partial agonist, weak antagonist on D2. Not fully understood. No abuse potential, does not cause CNS depression.
BOX: n/a
CON: MAOIs
ADR: None

Question 5

Benzodiazepines

Answer 5

IND: Anxiety
MOA: Agonist on post-synaptic GABA neuron in CNS. Increases permeability to Cl ions.
BOX: Use with Opioids: sedation, respiratory depression, coma, and death. Limit durations, monitor closely.
Abuse, misuse, addiction
Dependence and withdrawal: LIFE THREATENING SEIZURES from withdrawal
CON:
ADR:

Question 6

Alprazolam

Answer 6

IND: Anxiety
MOA: Benzo
BOX: Benzo
CON: Use with CYP inhibitors
ADR: Weight gain, weight loss. CNS depression, decreased libido, constipation
Short 1/2 life. Safer in elderly but peaks faster

Question 7

Clonzapam

Answer 7

IND: Anxiety, seizures
MOA: Benzo
BOX: Benzo
CON: NAG, Liver disease
ADR: Drowsy, ataxia, behavior, dizzy

Question 8

Lorazepam

Answer 8

IND: Anxiety, seizures
MOA: Benzo
BOX: Benzo
CON:
ADR: Injection site pain, Drowsy/sedation
Excessive parenteral dosing = kidney damage

Question 9

Diazepam

Answer 9

IND: Anxiety
MOA:
BOX:
CON: NAG/OAG, under 6 months, Myasthenia Gravis, respiratory impairment, hepatic impairment, sleep apnea
ADR: Drowsy
Lasts forever, long 1/2 life. Bad for elderly pt with lots of other meds.

Question 10

Oxazepam

Answer 10

IND: Anxiety, alcohol withdrawal
MOA: Benzo
BOX: Benzo
CON:
ADR: Drowsy/hypotension

Question 11

TCAs and MAOIs

Answer 11

Equally effective as SSRI’s for depression
Less tolerated, more SE
Drug interactions with MAOIs