Anxiety

Question 1

GAD

Answer 1

-AD are the drugs of choice for treatment
-takes 8-12 weeks for meds to work
-diagnosis requires persistent sx for most days for at least 6 months
-avoid stimulants and alcohol

Question 2

FDA approved drugs fpor GAD

Answer 2

duloxetine, venlafaxine, escitalopram, paroxetine (1st line)

Question 3

Other drugs used for GAD that aren’t FDA approved

Answer 3

-sertraline, pregabalin (1st line)
-alternatives: duloxetine, buspirone, hydroxyzine, pregabalin, bupropion

Question 4

Hydroxyzine GAD

Answer 4

-FDA approved
-BEERs list
-2nd line due to anticholinergic SE
-CI: 1st trimester
-Retrolental fibroplasia (can lead to blindness)

Question 5

Buspirone GAD

Answer 5

-FDA approved
-not for prn use
-takes 2 weeks to see effects
-not a control
-not addictive like BZD

Question 6

Pregabalin GAD

Answer 6

-not FDA approved
-no withdrawal sx seen when tapered over a week
-produces anxiolysis similar to BZD
-adjust dose if CrCl <60 ml/min

Question 7

Not approved for GAD treatment

Answer 7

ziprasidone, propranolol, tiagabine

Question 8

Managing sleep disturbances GAD

Answer 8

Use more sedating agents (pregabalin, hydroxyzine)

Question 9

GAD management for elderly

Answer 9

-Lexapro, Zoloft
-SNRIs might inc BP

Question 10

Managing neuropathic pain GAD

Answer 10

Pregabalin

Question 11

BZD CI

Answer 11

Allergy, SUD, myasthenia gravis, severe hepatic dx, COPD, sleep apnea, pregnancy/breastfeeding, narrow angle glaucoma, BBW w/ opiates

Question 12

BZD FDA approved for Anxiety

Answer 12

CLAD: Chlordiazepoxide, Clorazepate, lorazepam, alprazolam, diazepam

Question 13

BZD FDA approved for panic disorder

Answer 13

Clonazepam (Klonopin)

Question 14

BZD less lipophilic agents

Answer 14

-lorazepam and oxazepam
-slower absorption, slower onset, longer duration (small vd)
-less euphoria

Question 15

BZD more lipophilic agents

Answer 15

-Diazepam and clorazepate
-faster absorption, faster onet, shorter duration of action (large vd)
-more euphoria

Question 16

BZD shorter half life

Answer 16

-alprazolam, diazepam, oxazepam
-reach steady state fast w/ minimum accumulation

Question 17

BZD considerations

Answer 17

-high potency: clonazepam and alprazolam
-d/c of therapy can cause rebound anxiety, recurrence/relapse, withdrawal
-risk of withdrawal seizures inc w/ higher doses, long duration and concomitant med use

Question 18

BZD d/c strategy

Answer 18

-25% per week until 50% of dose is reached
-Then dec by 1/8 every 4-7 days
-for therapy that was > 8 weeks, taper over 2-3 weeks
-for therapy that was > 6 months, taper for 4-8 weeks
-therapy over a year, taper for 2-4 months

Question 19

BZD pregnancy

Answer 19

-inc risk for cleft lip/palate
-suicide risk for mother

Question 20

BZD to use in liver damage or elderly

Answer 20

oxazepam, temazepam, lorazepam

Question 21

Panic disorder

Answer 21

2 or more agoraphobic situations are now required to distinguish from specific phobia

Question 22

FDA approved drugs for Panic disorder

Answer 22

-Prozac, Paxil, Zoloft

Question 23

Not recommended in Panic disorder

Answer 23

buspirone, propranolol, tiagabine, trazodone, bupropion, APS, antihistamines

Question 24

First line treatment in Panic disorder (not all are FDA approved)

Answer 24

Lexapro, Celexa, Prozac, fluvoxamine, Paxil, Zoloft, venlafaxine XR

Question 25

BZD Panic disorder

Answer 25

-High potency (xanax and clonazepam) are preferred, but diazepam and lorazepam are possibly effective at higher doses -Should not be used as mono therapy in those with hx of depression or current depression -add to AD for 4-6 weeks (short terms) -optimize before augmenting

Question 26

Panic Disorder - Specific Phobia

Answer 26

-fear of object or situation -pt responsive to CBT (cannot use BZD if receiving CBT) -Evidence that Paxil and BZD can work if CBT fails

Question 27

First line therapy in SAD

Answer 27

Lexapro, fluoxamine, paxil, zoloft, venlafaxine, pregabalin -beta blockers are used for sx only

Question 28

Not recommended for SAD

Answer 28

buspirone, atenolol, imipramine, levetiracetam, quetiapine, propranolol

Question 29

FDA approved for SAD

Answer 29

sertraline, paroxetine, venlafaxine

Question 30

SAD treatment resistant

Answer 30

reserve MAOIs and APS (phenelzine and olanzapine) -if pt fails 2 AD

Question 31

PTSD

Answer 31

-CBT and eye movement desensitization/reprocessing are most effective nonpharm -TCA/MAOIs can be used but less effective bc SE -Bupropion SR not effective -BZD not effective (can impair CBT effects)

Question 32

PTSD FDA approved drugs

Answer 32

Zoloft and Paxil

Question 33

1st line in PTSD

Answer 33

SSRIs and venlafaxine

Question 34

PTSD with intrusive thought, hypervigilance

Answer 34

augment with risperidone, quetiapine, or olanzapine

Question 35

PTSD with nightmares

Answer 35

augment with prazosin

Question 36

PTSD with anger

Answer 36

augment with lamotrigine

Question 37

PTSD with sleep problems

Answer 37

augment with trazadone

Question 38

PTSD with anxiety, sleep, nightmares

Answer 38

augment with clonidine

Question 39

OCD

Answer 39

-can augment with low dose APS -taper after 1-2 years of treatment -CBT -Clomipramine use after failed SSRI due to ADR -3 AD trail (1 including cloipramine) before augmentation

Question 40

FDA approved drugs for OCD

Answer 40

Prozac, Paxil, Zoloft, fluvoxamine