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PPT Phase II > Anxiety Disorder Management > Flashcards

Anxiety Disorder Management Flashcards

1
Q

Give 3 examples of benzodiazepines used for anxiety disorders

A

diazepam
lorazepam
temazepam

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2
Q

name 3 SSRIs

A

citalopram
fluoxetine
sertraline

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3
Q

Name 2 SNRIs

A

duloxetine

venlafaxine

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4
Q

what is the mechanism of action of benzodiazepines?

A

facilitate and enhacne binding of GABA to the GABA-A receptor in the CNS.

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5
Q

Name 5 useful effects of benzodiazepines

A
  1. sedation
  2. anterograde amnesia
  3. anxiolytic actions
  4. anticonvulsant activity
  5. reduction of skeletal muscle tone
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6
Q

when would it be useful to use a short-acting benzodiazepine and name an example.

A

As a hypnotic for inducing sleep but where you don’t want person to feel sedated in the morning.
e.e. temazepam

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7
Q

name a long-acting benzodiazepine and state when it would be useful to use it?

A

diazepam or lorazepam
useful as an anxiolytic with long duration of action as it prevents anxiety recurring. you can then give smaller doses to minimise sedation

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8
Q

abrupt cessation of benzodiazepines produces similar state to withdrawal of what other substance?

A

alcohol because alcohol also works on GABA-A receptors

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9
Q

Name some side-effects of benzodiazepams that you should warn patients of before taking them

A
  • drowsiness (operating machinery)
  • light-headedness
  • confusion (particularly in the elderly)
  • they can increase effects of other sedative substances such as alcohol.
  • tolerance (rebound insomnia on withdrawal can perpetuate benzo use)
  • dependence
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10
Q

Due to dependence, how long can benzodiazepines be prescribed for?

A

max 2-4wks

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11
Q

What would be the effect of a benzodiazepine overdose?

A

respiratory depression due to airway obstruction

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12
Q

what is the mechanism of action of buspirone?

A

unclear but partial agonist at 5-HT and alpha1-adrenoceptors and antagonist at certain dopamine receptors

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13
Q

what anxiety disorders would you not use buspirone?

A

insomnia as it has no sedative action and it is also ineffective for panic attacks

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14
Q

what is the first-line pharmacological treatment for generalised anxiety disorder?

A

SSRIs - e.g. sertraline

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15
Q

what is second-line pharmacological treatment for GAD?

A

SNRI e.g. venlafaxine

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16
Q

what is 3rd line pharmacological treatment for GAD?

A

pregabalin

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17
Q

what might you prescribe to help with the physical symptoms of anxiety?

A

beta-blocker e.g. propanolol

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18
Q

would you have more withdrawal problems with a drug with a short or long half life?

A

long half life.

You will get withdrawal symptoms for longer with a drug with a long half life

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19
Q

Name some aspects of sleep hygiene

A
  • regular sleep schedule (same time bed and wake)
  • relaxing bedtime routine
  • avoid stimulants e.g. caffeine
  • good sleep environment
  • exercise during day
  • get exposure to daylight
  • healthy eating
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20
Q

Name common side effects of SSRIs

A
  • GI upset
  • changes in appetite and weight (loss or gain)
  • hyponatraemia which can cause confusion in elderly
  • suicidal thoughts may increase within first few weeks
  • some can prolong QT interval, predisposing to arrhythmias
21
Q

what is the best treatment for OCD?

A

psychological therapies, with CBT, to enable the person to tolerate anxiety. SSRIs can be given alongside.

22
Q

what is the mechanism of action of “Z-drugs” and name 3

A

interact with postsynaptic GABA-A receptors but have a shorter duration of action then benzos.
e.g. zaleplon, zolpidem, zopiclone

23
Q

if a person needs help getting to sleep, what drugs would be best to use?

A

short-acting hypnotics e.g. zolpidem

24
Q

if a person wakes in teh middle of the night, what drugs would be best for them?

A

temazepam or zopliclone due to them being longer-acting

25
Q

why should hypnotic drugs only be used for short periods of time e.g. 2wks

A

due to tolerance and dependence - can get rebound insomnia when drug is stopped if person is dependent

26
Q

what is the antidote to benzodiazepine overdose?

A

flumazenil - should not be used when a mixed overdose is suspected as it may precipitate seizures and having blocked the benzodiazepine receptor means the seizure will be difficult to treat

27
Q

What drugs can be used for rapid tranquilisation?

A

lorazepam, olanzapine or haloperidol AND promethazine

28
Q

how long does oral lorazepam take to work?

A

allow at least 1 hour

29
Q

if you give IM lorazepam for rapid tranquilisation, how long should you wait for a response?

A

allow 30 mins

30
Q

if IM lorazepam has not worked, what 2 options could you use next?

A
  • IM olanazpine (only after >1hr post lorazepam IM)
    OR
  • haloperidol with promethazine OR lorazepam (only in pt with no cardiac disease)
31
Q

what are risks of using benzos for rapid tranquilisation?

A
  • loss of conscoiusness
  • respiratory depression or arrest
  • cardiovascular collapse
  • disinhibition
32
Q

what risks are there with using antipsychotics for rapid tranquilisation?

A
  • loss of consciousness
  • cardiorespiratory complications
  • seizures
  • akathisia
  • dystonia
  • dyskinesia
  • neuroleptic malignant syndrome
33
Q

after IM rapid tranquilisation, what should be monitored every 15 mins for at least 1 hour?

A 
Temperature
pulse
BP
hydration
level of consciousness
resp. rate
34
Q

what is the MoA of tricyclic antidepressants and name 3

A

inhibit re-uptake of monoamine neurotransmitters by competitive inhibition of monoamine transporter proteins.
E.g. amitryptyline, imipramine, lofepramine

35
Q

name some common side effects of TCAs

A

sedation, antimuscarinic effects (dry mouth, constipation, urinary retention, impotence), excessive sweating and tremor, reduce seizure threshold in epileptics, cardiotoxicity in overdose

36
Q

what class of drug is mirtazapine and what is the MoA?

A

presynaptic alpha-2-adrenoceptor antagonist and
5-HT-2C receptor antagonist.
reduces negative feedback inhibition of serotonin release from raphe nucleus neurons

37
Q

what class of drug is reboxetine?

A

selective noradrenaline reuptake inhibitor (NRI)

38
Q

what class of drug are phenelzine and tranylcypromine?

A

irreversible monoamine oxidase A and B inhibitors (MAOIs)

39
Q

what side effects should you warn patients of when starting them on MAOIs?

A
  • postural HTN
  • irritability and insomnia (as they have similar structure to amphetamine)
  • acute overdose produces toxic effects after 12hrs
  • avoid foods containing tyramine (cheese, yeast extracts etc.) as it can cause vasoconstriction and HTN with a throbbing headache
40
Q

what should you not use MAOIs in combination with?

A

TCAs or SSRIs

41
Q

what class of drug is moclobemide?

A

reversible inhibitor of monoamine oxidase A

42
Q

how would you manage mild to moderate depression first-line?

A

psychological therapies and CBT

43
Q

when should you add in drug therapy to psychological therapies in depression?

A

when it is prolonged/moderate/severe depression

44
Q

when moving onto pharmacological therapy in depression, what is first line?

A

SSRIs

45
Q

what is 2nd line drug use in depression?

A

SNRIs

46
Q

3rd line drug use in depression?

A

combination e.g. SSRI + mirtazapine

or add lithium

47
Q

When is ECT used?

A

in severe or treatment-resistant depression, or when you need something to work quicker than drugs

48
Q

how long should you try an antidepressant for before deciding to switch?

A

at least 4 weeks due to delayed onset of action

PPT Phase II (37 decks)

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