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competency 10/11 > neuro: anxiety > Flashcards

neuro: anxiety Flashcards

1
Q

OCD tx

A

1st line: SSRI
2nd: clomipramine
3rd: venlafaxine

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2
Q

approach to dosing

A

􀂱 Starting Dose must be LOW: (start low go slow)
􀂇 Transient jitteriness in the initial 1-2 weeks of starting antidepressant.
􀂇 Start antidepressant at with low dose; consider Benzodiazepine as adjunct
􀂱 Maintenance Dose may be at HIGH end of the range.
􀂇 Effective maintenance dosing of antidepressants for treatment of Anxiety
Disorders are on the high end of the dose range (e.g. Fluoxetine 60-80mg/day vs 20mg for MDD)

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3
Q

serotonergic antidepressant

A
  • effective for ‘excessive worrying’ type of symptoms in anxiety
    􀂇 Onset at least 1-2 months
    􀂇 Full response generally 3 months
    􀂱 Duration of treatment at least 1-2 years, typically long-term.
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4
Q

bzd

A

adjunctive: effective for physical sx of anxiety eg. muscle tension
- fast onset of action, can be within 30 mins for lorazepam
- aim for short term (3-4 months) of treatment, prn dosing, then taper
- anxiolytic, hypnotic, muscle relaxation, anticonvulsant, amnesic properties

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5
Q

tolerance of bzd

A
  • to hypnotic actions: common, develop within days
  • to anxiolytic action: less common
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6
Q

bzd dependence

A

avoid abrupt cessation after weeks of continued use (withdrawal)
- gradual taper required

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7
Q

high potency bzd agents

A

usually preferred in aniety disorders
- clonazepam, lorazepam, alprazolam xr for panic disorder

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8
Q

cautions to bzd

A
  • parodoxical excitement esp in children and elderly
  • dependence and withdrawal sx can occur esp in pt w hx of drug dependence
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9
Q

tx not recommended

A
  • kava: risk of hepatotoxicity
  • chamomile: avoid in pregnancy
  • valerien: incr gaba
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10
Q

FDA-approved bzd for treatment of general anxiety

A

alprazolam, diazepam, lorazepam

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11
Q

escitalopram dosing

A

10-20mg
PD, SAD: 5mg

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12
Q

fluoxetine

A

Prozac

20mg starting dose, PD: 5mg

max 80mg

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13
Q

fluvoxamine

A

Faverin

50mg, PD: 25mg
max 300mg

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14
Q

paroxetine

A

Seroxat IR

20mg
40-60mg

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15
Q

sertraline

A

Zoloft

5mg
200mg

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16
Q

venlafaxine XR

A

Efexor XR

37.5-75mg
75-225mmf

17
Q

duloxetine

A

Cymbalta

30-60mg
max 60-120mg

18
Q

clomipramine

A

Anafranil

25mg
max 100-250mg

19
Q

mirtazapine

A

Remeron

15mg
max 30mg

20
Q

alprazolam

A

Xanax

0.5-4mg
max 4-10mg

21
Q

clonazepam

A

Rivotril

0.5-1mg
max 1-4mg

22
Q

diazepam

A

Valium

4-15mg
max 5-40mg

23
Q

lorazepam

A

Ativan

1-3mg
max 2-8mg

24
Q

hydroxyzine

A

Atarax

usually 25mg TDS-PRN
max 400mg

25
Q

proporanolol

A

10-80mg
max 80-160mg

26
Q

pregabalin

A

Lyrica

150-600mg for GAD, if SSRI/SNRI ineffective or intolerable
max 600mg

27
Q

which bzd not metabolised by cyp3a4?

A

lorazepam

28
Q

bzd + opioids

A

incr mortality, cns depression
- avoid combi or limit dose and duraiton

29
Q

all serotonergic antidepressants

A

promote 5HT transmission

30
Q

ALL antidepressants that promote 5-HT transmissions have efficacy for
anxiety disorders

A

effective for ‘worrying/apprehension’ type of sx
- initiate at v low doses and gradually titrate up to max dose range

31
Q

time to respond to antidepressants

A

may take 6-12 weeks
maximum response take 3 months

32
Q

discontinuation of antidepressants

A

gradual taper, to avoid discontinuation sx
- decr dose by 10-25% every 1-2weeks

33
Q

early side effects to antidepressants use

A

possible incr anxiety during first 1-2 weeks
- nausea, headache, insomnia/sedation usually subsides after 2-3 weeks of continued treatment

34
Q

long-term side effects to antidepressants use

A

sexual dysfunction and weight gain r common
- may lead to discontinuation of treatment

35
Q

drugs that incr NE release

A

SNRI: venlafaxine, duloxetine
NaSSA: mirtazapine
NDRI: bupropion
TCA

will incr bp

36
Q
A

competency 10/11 (31 decks)

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