Chapter 67: Anxiety Disorders Flashcards

1
Q

Which key drugs cause anxiety?

A
Albuterol (if used too frequently or incorrectly)
Antipsychotics (e.g., aripiprazole, haloperidol)
Bupropion
Caffeine, in high doses
Decongestants
Illicit drugs
Levothyroxine (if therapeutic OD occurs)
Steroids
Stimulants
Theophylline
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2
Q

What are natural products used for anxiety & their warnings/SE

A
  • St. John’s Wort (strong 3A4 inducer, causes photosensitivity & is serotonergic)
  • Valerian (some products may be contaminated with liver toxins)
  • Passionflower is safe & “possibly effective”
  • Kava (severe liver damage, NOT recommended)
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3
Q

Which drug class is recommended first line for anxiety

A

SSRIs

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4
Q

SSRIs will not provide immediate relief of anxiety. They take at least ____ at higher doses for a noticeable effect

A

4 weeks

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5
Q

Which medication is a more favorable add-on medication than BZDs in elderly patients d/t less sedation

A

Buspirone

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6
Q

Buspirone will not provide immediate relief of anxiety. It will take at least ____ for effect

A

2-4 weeks

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7
Q

Which medication can be used short-term, as needed, as an alternative to BZDs

A

Hydroxyzine (Vistaril)

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8
Q

Which medications are not FDA approved for anxiety but has shown benefit in patients with anxiety and neuropathic pain

A

Pregabalin (Lyrica) & Gabapentin (Neurontin)

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9
Q

Which medication is not FDA approved for anxiety but can reduce symptoms of stage fright or performance anxiety (e.g., tremor, tachycardia)

A

Propranolol (Inderal LA)

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10
Q

MOA of buspirone is unknown, but its effects may be due to its affinity for which receptors

A

5-HT1A and 5-HT2

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11
Q

CI for buspirone

A

Do not use with MAOi within 14 days

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12
Q

Which medication used for anxiety could you give someone with a history of drug abuse

A

Buspirone

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13
Q

MOA of BZDs

A

Enhance GABA, which is an inhibitory neurotransmitter, causing CNS depression

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14
Q

Which drug class can be useful for short-term treatment of acute anxiety that is preventing restful sleep and disrupting life (i.e., recent death of a loved one, natural disaster, etc.)

A

benzodiazepines

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15
Q

Due to the risk of dependency, benzodiazepines should only be used for ____ and then discontinued. If used for longer periods of time, they must be tapered off slowly to prevent withdrawal symptoms

A

1-2 weeks

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16
Q

BZDs are inappropriate to use in patients older than 65 years and have a high risk of confusion, dizziness and falls in the elderly. If a BZD is used, which ones are safer to use in elderly patients and patients with liver impairment?

A

L-O-T

  • Lorazepam
  • Oxazepam
  • Tamezepam
17
Q

What are the preferred BZDs for anxiety in everyone besides elderly and patients with liver impairment?

A

CLAD

  • Clonazepam
  • Lorazepam
  • Alprazolam
  • Diazepam
18
Q

What are the preferred BZDs for sleep

A

Lorazepam or temazepam

19
Q

Alprazolam brand name

A

Xanax

20
Q

Clonazepam brand name

A

Klonopin

21
Q

Diazepam brand name

A

Valium

22
Q

Lorazepam brand name

A

Ativan

23
Q

BZD boxed warning

A

Use with opioids can result in sedation, respiratory depression, coma and death

24
Q

Clonazepam and diazepam have a CI for

A

severe liver disease

25
Q

Are BZDs safe in pregnancy

A

No - crosses placenta

26
Q

BZD side effects

A

Somnolence, dizziness, ataxia

27
Q

What schedule are BZDs

A

C-IV

28
Q

Which BZDs are commonly used for alcohol withdrawal syndrome?

A

Lorazepam, diazepam and chlordiazepoxide

29
Q

Antidote for BZDs

A

Flumazenil

30
Q

Alprazolam is CI with

A

Strong 3A4 inhibitors (e.g., ketoconazole, itraconazole)

31
Q

Which medication used for anxiety is scored to easily break in half or into thirds?

A

Buspirone