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Flashcards in 2 - Anxiety Disorders Deck (22):
1

non-pharms for anxiety

-therapy or counselling
-stress-reduction techniques
-relaxation
-sleep and exercise
-reduce caffeine and alcohol
-time management

2

In general, what meds are first line?
Why?

SSRIs or SNRIs

*1st line bc of tolerability and better safety profile as compared to TCAs and MAOIs

3

Once the target dose is reached, how long may it take to see improvement?

2-8 weeks

*optimal response may take up to 12 weeks

4

How long should you use pharmacotherapy for?

for at least 12-24 months in most patients

5

Why are BZD second line?

abuse, sedation, cognitive impairment and withdrawal

*recommend them as short term treatment while starting SSRI or SNRI

6

What classes are options for second or third line treatment or adjunctive treatment?

-second generation antipsychotics (SGAs)
-anticonvulsants

*they are used as last resort due to side effects and limited number of studies for their efficacy in this setting

7

Panic Disorder: What are 1st line agents?

SSRIs or venlafaxine (SNRI)

8

Panic Disorder: What are 2nd line agents?

imipramine or clomipramine (TCAs), or mirtazapine, BZD for short term or PRN

9

Panic Disorder: What are 3rd line agents?

phenelzine or tranylcypromine (irreversible MAOIs)

*not used much due to s/e and dietary restrictions (need low tyramine diet)

10

Social Anxiety Disorders: 1st line agents?

SSRIs and venlafaxine (fluoxetine may be less effective)

-Pregabalin high dose ( > 600mg/day)

11

Social Anxiety Disorders: 2nd line agents?

-phenelzine (irreversible MAOi)
-gabapentin
-clonazepam, bronazepam

12

Social Anxiety Disorders: 3rd line agents?

SGAs (olanzapine, quetiapine, risperidone)

13

Social Anxiety Disorders:
What drugs can help if taken 30-60 mins prior to anxiety-provoking event?

low dose propranolol or atenolol (beta blockers)

14

Specific Phobia Treatment?

exposure therapy and/or BZD prior to exposure

15

Generalized Anxiety Disorder:
Symptoms have to be present for how long

6 months

16

Generalized Anxiety Disorder: 1st line?

-SSRIs and SNRIs
-Pregabalin (provides fast relief in approx 1 week)

17

Generalized Anxiety Disorder: 2nd line?

-quetiapine XR
-imipramine
-buproprion
-BZD
-busprione
-hydroxyzine

18

Generalized Anxiety Disorder: 3rd line?

-adjuvant pregabalin
-mirtazapine
-SGAs as adjuvant Tx

19

Anxiety Disorders and Pregnancy:
What is 1st line?

-CBT and interpersonal therapy
-mediation, relaxation

20

Anxiety Disorders and Pregnancy:
If medication is necessary, which ones are safe?

SSRIs and SNRIs or BZDs

*avoid paroxetine in pregnancy - cardiac abnormalities

SSRIs in 1st trimester may be linked with spontaneous abortions

SSRIs in 3rd trimester may cause behavioural syndrome of newborn (agitation, tremors, increased muscle tone, breathing probs) - fluoxetine and paroxetine are more likely bc they cross placenta more than other SSRIs

Don't use BZD in 1st trimester

21

Anxiety Disorders and Breastfeeding:
What are first line after non-pharms? Why?

Paroxetine or sertraline
-low concentration in breast milk
-undetected in plasma of child

22

Anxiety Disorders and Breastfeeding:
Why do we avoid BZD?

potential accumulation, sedation and impaired temperature regulation in the infant

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