Anxiety Flashcards
(120 cards)
1
Q
true or false: anxiety is the most commonly occurring psychiatric disorder
A
true
2
Q
anxiety usually develops before the age of
A
30
3
Q
is anxiety more common in men or women
A
women
4
Q
What is anxiety
A
a normal and beneficial response to situations that are perceived as threatening, frightening, or disturbing. Becomes a disorder when it significantly impacts functioning
5
Q
Drugs that cause anxiety (6)
A
Albuterol, caffeine, decongestants, levothyroxine, steroids, stimulants (ADHD meds)
6
Q
what 6 medication classes may be used for anxiety?
A
Buspirone, BZDs, SSRIs, SNRIs, Hydroxyzine, herbal supplements
7
Q
What kind of drug is buspirone?
A
serotonin (5HT)-1a receptor agonist
8
Q
What specific anxiety disorder is treated by buspirone
A
generalized anxiety disorder (GAD)
9
Q
The were two cons listed on the slides about buspirone….
A
often not dosed effectively and many patients and providers are skeptical of efficacy
10
Q
Buspirone dose
A
10-15mg TID
11
Q
what kind of interactions should we look for with buspirone
A
3A4 inducers and inhibitors
12
Q
How long until we see efficacy from buspirone
A
3-4 weeks for initial efficacy
13
Q
Which 4 BZDs are used for anxiety
A
alprazolam, lorazepam, clonazepam, diazepam
14
Q
Why don’t guidelines support the use of BZDs for anxiety
A
misuse potential of BZDs
15
Q
are BZDs or SSRIs more effective for anxiety according to studies
A
BZDs
16
Q
How are BZDs dosed incorrectly in practice?
A
Usually given PRN so it doesn’t work well for anxiety
17
Q
Should BZDs be used long-term or short term?
A
short term, may cause dependence or tolerance
18
Q
Acute withdrawal of BZDs may lead to what?
A
life-threatening seizures
19
Q
there are warning of prescribing BZDs for anxiety with ____ because of increased overdose death risk
A
opioids
20
Q
BZDs with active metabolites have a higher ___ ___
A
fall risk
21
Q
Which BZDs do not have active metabolites?
A
alprazolam, lorazepam, clonazepam, oxazepam
22
Q
there are 3 BZDs that have a long acting active metabolite that increase risk for fall, especially in elderly
A
diazepam, clorazepate, and chlordiazepoxide
23
Q
Side effects of BZDs (5)
A
sedation, paradoxical excitement, swallowing difficulties, impaired memory/recall, and psychomotor impairment
24
Q
Can you discontinue BZDs immediately?
A
No, they must be tapered
25
BZDs and Beers criteria
usually considered inappropriate in elderly due to fall risk and paradoxical rxn
26
Which BZDs would we prefer in elderly?
Prefer LOT, lorazepam, oxazepam, and temazepam (short acting without active metabolites)
27
What specific type of anxiety is Hydroxyzine Pamoate FDA approved for?
generalized anxiety disorder (GAD)
28
Why would we use Hydroxyzine pamoate HCL salt over Hydroxyzine?
so the patient can take a dose that's 10mg lower
29
How is hydroxyzine taken for anxiety and sleep
prn, especially if history of substance abuse
30
usual dose of hydroxyzine
25mg-50mg TID, usually at bedtime
31
What does hydroxyzine work on
serotonin 5HT2A antagonist and H1 receptor antagonist
32
Side effects of hydroxyzine (3)
sedation, QTc prolongation, anticholinergic side effects
33
Hydroxyzine and beers criteria
not recommended for use in elderly patients do to fall risk and anti-cholinergic side effects
34
how does propanolol help anxiety
decreases the physiological symptoms associated with anxiety like tachycardia, sweating, and flushing
35
what kind of anxiety is propanolol most helpful for
performance and situational anxiety (PRN)
36
dose of propanolol
low doses, 10-20mg BID/TID
37
What in a pts med history should be evaluated before prescribing propanolol
hx of asthma and CVD conditions
38
cons of propanolol for anxiety
may mask hyperglycemia and make depression worse
39
5 natural products used for anxiety
Kava, St Johns Wort, Passionflower, Valerian, Chamomile
40
Is Gabapentin and pregabalin FDA approved for anxiety
No, but they are still occasionally prescribed
41
Pts who have ____ and ____ with anxiety may be prescribed gabapentin or pregabalin
bipolar disorder and neuropathic pain
42
What condition besides anxiety is quetiapine usually prescribed for?
sleeplessness
43
should quetiapine be used for insomnia
"sleep medicine does not endorse the use of quetiapine for insomnia"
44
6 types of anxiety
generalized anxiety
panic disorder
social anxiety
obsessive compulsive disorder
ptsd
anxiety associated with other medical conditions
45
Drugs that induce anxiety
cocaine, beta agonists, caffeine, corticosteroids
46
what is the fear center of the brain and which neurotransmitter effects it
amygdala, norepinephrine
47
what neurotransmitter counteracts GABA
glutamate
48
what neurotransmitter does GABA counteract
norepinephrine
49
what does glutamic acid decarboxylase do?
converts glutamate to GABA in the CNS
50
What kind of drug is beneficial at 5HT1a serotonin receptors (agonist, antagonist, inverse agonist, partial agonist)
partial agonist
51
Duration and onset of BZDs for anxiety
quick onset, very effective
52
Onset of SSRIs, SNRIs, and other antidepressants for anxiety
take 2-4 weeks for onset of effects
53
benefits of ketamine for anxiety
nasal spray, very quick acting
54
what kind of drug is buspirone and what receptor does it act on
partial agonist, 5HT1a receptor
55
buspirone onset of action compared to BZD
longer onset of action
56
what are the benefits of Buspirone
low abuse potential, little to no withdrawal
57
Would you choose BZDs or Buspirone for panic disorders? Why?
I would choose BZDs, faster onset of action
58
Side effects of propanolol for anxiety
hallucinations, vivid dreams, lethargy, impotence
59
What must you do for the initial dose of propanolol
may need to test dose initially
60
what receptor does hydroxyzine work on
histamine H1 antagonist
61
Clonidine receptor target
alpha 2 agonist
62
what two kinds of anxiety does clonidine treat
panic attacks and anxiety associated with withdrawal
63
what is the receptor target of ondansetron
5HT3
64
what is the receptor target of Ketanserin
5HT2
65
Tiagabine blocks the uptake of what
GABA uptake blocker
66
target of d-cycloserine and memantine
NDMA receptor
67
LY354740 target
mGluR2/3 agonist
68
fenobam target
mGluR5
69
What is the first line agent for all kinds of anxiety
SSRIs and SNRIs
70
what kind of antipsychotics are approved for anxiety and treatment resistant OCD
atypical antipsychotics like aripiprazole and risperidone
71
What is generalized anxiety disorder
excessive anxiety/worry around a number of life events that is difficult to control
72
How long does anxiety have to be present to be classified as GAD?
at least 6 months
73
Do be classified as GAD, pt must have at least 3 symptoms including (7)
restlessness/feeling keyed up or on edge
being easily fatigued
difficulty concentrating
irritability
muscle tension
sleep disturbances
74
What is the first line therapy for GAD
SSRI antidepressants
75
What two SSRIs are approved for GAD
Paroxetine and escitalopram
76
SNRIs are a useful first line if patient also has what?
pain syndrome
77
What drug class can be used as a bridge therapy before SSRIs/SNRIs kick in
BZDs
78
What medication can be used prn for anxiety or symptoms of anxiety
hydroxyzine
79
What is social anxiety disorder
persistent fear about social and or performance situations in which the patient fears embarrassment or humiliation that is unreasonable
80
non pharm options for social anxiety disorder
avoid the specific situations
81
Duration of symptoms for social anxiety disorder
at least months
82
approved SSRIs for Social anxiety disorder
paroxetine and sertraline
83
approved SNRI for social anxiety disorder when SSRIs fail
venlafaxine
84
What class of drug may be useful for non-generalized performance related Social anxiety disorder
Beta-blockers
85
what drug is used for treatment resistant SAD
phenelzine
86
What is panic disorder
recurrent, unexpected panic attacks
87
what is an abrupt surge of intense fear or discomfort that reaches a peak in minutes and is accompanied by at least 4 physical and psychological symptoms
panic disorder
88
what symptoms are seen in panic disorder (7)
sweating, palpitations, nausea, dizziness, fear of losing control, going crazy, or dying
89
What is agoraphobia
fear of places that may cause panic or anxiety
90
true or false, panic disorder is characterized by at least one attack followed by one month or more of concern of attack or change of behavior related to attack
true
91
what is first line treatment for panic disorder
SSRIs
92
Which SNRI is approved for treatment of panic disorder
Venlafaxine
93
What is the recommendation for BZDs in panic disorder
should not be first line therapy unless there is an inadequate response to serotonin drugs
94
which BZDs are FDA approved for panic disorder
alprazolam and clonazepam
95
what does bridge therapy mean?
using benzodiazepines for panic attacks until SSRIs kick in.
96
What are obsessions
recurrent thoughts or images that are intrusive and cause anxiety, patient attempts to ignore but cannot
97
what are compulsions
repetitive behaviors in response to obessions
98
what are the two components of OCD
obsessions and compulsions
99
what can be expected by treatment of OCD
25-50% reduction in symptoms
100
what is the first line treatment for OCD
SSRIs
101
What is the second line therapy for OCD if patient fails SSRIs
Clomipramine (TCA)
102
Clomipramine's only indication is
OCD
103
Can antipsychotics be used in OCD
not FDA approved, may be used for augmentation therapy with SSRIs/SNRIs
104
SSRIs and SNRIs can be used with what drug class to help OCD
antipsychotics
105
Which antipsychotic is best for OCD
Risperidone
106
which drug is inconsistently effective for OCD
Aripiprazole
107
what is PTSD
exposure to real or threatened death, serious injury, or sexual violence
108
what are four components of PTSD
flashbacks, reexperiencing, avoidance, hypervigilance
109
negative alterations in mood or cognition is a component of PTSD
true
109
what is the first line agent for PTSD
SSRIs/SNRIs
110
what drug is helpful for sleep or nightmares in PTSD patients
prazosin
110
What drug class is not recommended for PTSD
BZDs
111
Monotherapy usually works for PTSD
false
112
what is often a result of PTSD
substance use
113
what non-pharm options are beneficial for PTSD
CBT and eye movement desensitization and reprocessing
114
where in the brain is the focus of PTSD and what neurotransmitter is involved
norepinephrine in the amygdala
115
Is there any prevention for PTSD
not really
116
SSRIs and SNRIs may cause what syndrome
Jitteriness syndrome
117
how do you avoid jitteriness syndrome with SSRIs and SNRIs
initial dose should be lower than doses used for depression and follow up appropriately
118
In PTSD, drug therapy is more effective in combat trauma compared to civilian trauma
false, more effective in civilian trauma because it is usually a one-time event
