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T&D II exam 1 > Anxiety > Flashcards

Anxiety Flashcards

1
Q

first line for anxiety

A

SSRI

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2
Q

how does SSRIs help with anxiety

A

increased serotonin – changes in RECEPTORs rather than acute actions

this helps normalize activation of amygdala (fear) and cortico-striata-thalamo-cortico loop (worry)

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3
Q

use of SSRI

A

anxiety disorder

reduce flashbacks, arousal, avoidance in ptns w/ PTSD

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4
Q

onset of SSRI

A

slow - 2-4 wks

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5
Q

example of SSRIs

A

Fluoxetine

Sertraline

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6
Q

SNRI use

A

anxiety
PTSD

AND CO-MORBID PAIN DISORDERS

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7
Q

how does SNRIs help

A

increased serotonin – down regulates/desensitzes post synaptic NE receptors – helps normalize activation of amygdala and CSTC loop

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8
Q

Major concern for compliance with SSRI/SNRIs

A

Jitters

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9
Q

Jitters take 2-3 wks to resolve, what can be co-prescribed for a short term

A

Benzodiazepine

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10
Q

Second line therapy

A

TCA: Imipramine

lot more side effects

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11
Q

what is indicated for status epilepticus

A

BDZs

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12
Q

BDZ MOA

A

ENHANCE GABA binding to GABAa receptor

CAUSES inc FREQ of Cl- channel opening – hyperpolarization
– inhibition of cell activity `

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13
Q

How do GABA interneurons help

A

they inhibit signaling from amygdala and inhibit initiation of CSTC loop

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14
Q

How does CNS effects progress with BDZ

A
  1. relief of anxiety
  2. Sleep induction
  3. Anesthesis
  4. Coma and death
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15
Q

When do you see coma and death with BDZ

A

only in conjuction with other depressants - ethanol, opioids

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16
Q

BDZ: lipid soluble or insolube?

what prevents it absorption?

A
  • Highly lipid soluble
    can cross placenta, get into br milk
  • Antacids (from GI tract)
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17
Q

what inhibits Phase I metabolism (fast)

A

Cimetidine

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18
Q

BDZ’s effect on CYP 450

A

does NOT induce or inhibit CYP 450

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19
Q

BDZ half life and the resulting effect

A

long

can accumulate w/ multiple dosing

20
Q

metabolites from phase II (slow) of BDZ

what are they useful for
why

A

Oxazepam
Lorazepam

ptns with liver disease, shorter half life than BDZ

21
Q

SE of BDZ

A
  • drowsiness confusion
  • ANTEROGRADE amnesia
  • Rebound
22
Q

BDZ type of metabolism

A

hepatic

23
Q

BDZ contraindicated in COPD

A

Midazolam

24
Q

Which BDZ have potential for birth defects when used during ___ of pregnancy

A

Chlordiazepoxide
Diazepam

first 3 mo

25
Q

Tolerance seen/not seen in

BDZ

A

tolerance: hypnotic, muscle relaxant, anticonvulsant

not in anxiolytic effects

26
Q

what type of dependence can occur and when

BDZ

A

physical dependence

extended therapy

27
Q

Which drugs have more severe sx for pts with withdrawal

what are the sx

A

shorter half life

Rebound insomnia, anxiety, SEIZURES

28
Q

How should ptns be withdrawn from BDZ

A

gradually over the course of weeks

29
Q

Direct muscle relaxant

A

diazepam

30
Q

antidepressant, panic disorder, agoraphobia

A

Alprazolam

31
Q

Rebound anxiety and rebound insomnia very common

A

Triazolam

32
Q

Antiemetic

A

Lorazepam

33
Q

Antidote for BDZ overdose

A

Flumazenil

give IV

34
Q

Non-BDZ

A 
Buspirone
Pregabalin
Meprobamate
Propranolol
Hydroxyzine
Mirtazapine
35
Q

MOA Buspirone

A

serotonin agonist - post and presynaptic

36
Q

Use Buspirone

A

Generalized anxiety disorder

given to augment SSRI

37
Q

possibility of dependence w/ Buspirone?

A

NO

38
Q

MOA pregabaline

A

blocks voltage sensitive calcium channels

  • binds to presynaptic N and P/Q channel a2d subunits
  • prevents release of excitatory NT in amygdala and CTSC
39
Q

Use pregabaline

A

GAD

Social generalized

40
Q

Meprobamate is contraindicated in

A

porphyrias

41
Q

MOA Propranolol

A

nonselective Beta-Adrenergic blocker

42
Q

Use Propranolol

A

reducing somatic sx of anxiety

  • palpitations, sweating, tachy

short term situation

43
Q

Stage/exam fright

A

Propranolol

44
Q

Hydroxyzine

A

Antihistamine
(H1 receptor antagonist)

sedation

GAD w/ insomnia

45
Q

Mirtazapine

A

5HT2 receptor antagonist
augment SSRI in GAD w/ insomnia

WEIGHT gain , sedation

46
Q

Social non-generalized anxiety

A

BZ

Propranolol

T&D II exam 1 (8 decks)

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