Anxiety

Question 1

What part of the brain handles fear?

Answer 1

amygdala to prefrontal

Question 2

What part of brain handles worry?

Answer 2

cortico-striato-thalamo-cortical circuit

Question 3

What general neurotransmittes are involved in fear?

Answer 3

serotonin, GABA, glutamate

Question 4

What neurotransmitter is dominant in the pathway of worry?

Answer 4

dopamine

Question 5

How are sodium channels involved with neurotransmitters and associated drugs?

Answer 5

gabapentin/pregabalin block release of glutamate

Question 6

What is buspirone’s MOA compared to SSRI?

Answer 6

5-HT1A agonist and this is similar to antipsychotics

Question 7

What is the reason for doctors wanting buspirone for immediate anxiety relief?

Answer 7

NONE just as slow as AD
if want speed use benzos

Question 8

Since we know norepinephrine can cause flight or fight, how does SNRI’s actually help anxiety?

Answer 8

worsen at beginning but eventually beta receptors are down regulated

Question 9

How can we limit nightmares and how do they occur?

Answer 9

alpha 1 stimulation
prazosin can block

Question 10

What OTC/ commercial drugs can mimic anxiety?

Answer 10

decongestant, caffeine

Question 11

GENERAL First line meds for GAD?

Answer 11

SSRI,SNRI, pregabalin

Question 12

If a patient has anxiety and seizure which medication should we avoid?

Answer 12

bupropion

Question 13

When should buspirone not be used?

Answer 13

comorbid depression

Question 14

Which SSRI has less insomnia, agitation and DI?

Answer 14

citalopram

Question 15

Which anxiety med are we concerned with QTc?

Answer 15

citalopram

Question 16

When would duloxetine be an interesting add for anxiety?

Answer 16

comorbid pain

Question 17

Which SSRI is most activating?

Answer 17

fluoxetine

Question 18

Which medications can cause withdrawal?

Answer 18

SNRI

Question 19

Why does fluvoxamine suck?

Answer 19

DI- CYP1A2 2C19

Question 20

When is hydroxyzine an good add?

Answer 20

comorbid insomnia

Question 21

When is mirtazipine helpful?

Answer 21

sleep

Question 22

Issues with mirtazapine?

Answer 22

weight gain, appetite

Question 23

Issues with paroxetine?

Answer 23

most sedating of SSRI, lots of weight gain, DI

Question 24

Issues with sertraline?

Answer 24

more insomnia, agitation, dizziness than other SSRI

Question 25

Which medications have issues with sex dysfunction?

Answer 25

SSRI-NOT sertraline SNRI- Venlafaxine, duloxetine

Question 26

What medication withdrawal can mimic GAD?

Answer 26

alcohol, sedatives, benzos

Question 27

What antidepressant is best known to be prone to cause anxiety?

Answer 27

bupropion

Question 28

What other medications can cause GAD sx?

Answer 28

CS, stimulants

Question 29

Sx of anxiety?

Answer 29

worry, poor concentration, restless, irritable, issues with sleep, fatigue

Question 30

What scale can we use in practice to assess anxiety?

Answer 30

GAD-7

Question 31

Non pharm for anxiety?

Answer 31

exercise, reduce caffeine, CBT, relaxation

Question 32

How good is CBT therapy?

Answer 32

comparable to drugs

Question 33

Which of the SSRI's and SNRIs are first line for GAD?

Answer 33

SSRI- paroxetine, sertraline, escitalopram SNRI- duloxetine, venlafaxine PREGABALIN

Question 34

What is 2nd line for GAD?

Answer 34

Benzo- short term= alpraz, lorazepam, diazepam bupropion buspirone hydroxyzine

Question 35

Patient has GAD and old what option?

Answer 35

Escitalopram or sertraline

Question 36

Patient has GAD and insomnia?

Answer 36

pregabalin or hydroxyzine

Question 37

Patient pregnant and GAD?

Answer 37

NO benzo or paroxetine

Question 38

Patient has GAD and bipolar mania?

Answer 38

quetiapine

Question 39

Patient has GAD and bipolar depression?

Answer 39

pregabalin

Question 40

What anxiety condition will probably utilize prazosin?

Answer 40

PTSD

Question 41

When to see effect of buspirone?

Answer 41

2 weeks or LONGER

Question 42

Why are antipsychotics not used in GAD?

Answer 42

bad s/e

Question 43

AT what dose is venlafaxine more NE?

Answer 43

>150

Question 44

When to see improve of GAD and when at max, and duration?

Answer 44

Improve in2-4 weeks max at 12 weeks duration 1-2 years

Question 45

When is benzos role useful?

Answer 45

anticipate acute attack

Question 46

Although no evidence of clonazepam in GAD, why use?

Answer 46

longer half life and avoids peaks and troughs

Question 47

Why not use alprazolam?

Answer 47

SUPER short duration

Question 48

Benefits of clonazepam and diazepam?

Answer 48

longer half life

Question 49

When to use lorazepam?

Answer 49

haptic issues

Question 50

s/e of benzos?

Answer 50

ataxia, dizzy, sedation or even insomnia, depression

Question 51

What benzos are better in elderly?

Answer 51

LOT lorazepam oxazepam temazepam

Question 52

What are signs of benzo withdrawal?

Answer 52

seizures, sweat, tremor, NV, anxiety

Question 53

What is the antidote for benzos? Why is it not used often?

Answer 53

flumazenil causes seizures

Question 54

Why is venlafaxine not good in elderly?

Answer 54

HTN

Question 55

Criteria for Panic disorder?

Answer 55

4 of palpitations, sweaty, tremble, N

Question 56

What is the difference between panic attack and disorder?

Answer 56

attack- 4 or more sx come on suddenly and peak at 10 min disorder-recurrent of at least 1 attack and a month of worrying of another attack

Question 57

Which SSRI has more gi issues?

Answer 57

sertraline

Question 58

What is first line for PD?

Answer 58

same as Gad just no pregabalin and add fluoxetine

Question 59

What is second line for PD?

Answer 59

TCA (clomipramine and imipramine), BZD

Question 60

When to get remission in PD?

Answer 60

6 months

Question 61

When should we think of switching medications if not working in PD?

Answer 61

6-8 weeks

Question 62

What is the working theory around Social Anxiety disorder?

Answer 62

DOPAMINE Dfx

Question 63

How long must you have social anxiety to be diagnosed?

Answer 63

6 months

Question 64

What's the difference between generalized and not SAD?

Answer 64

generalized= all situations non- a few

Question 65

What is first line for SAD?

Answer 65

CBT, SSRI, SNRI, pregabalin

Question 66

What can we give for performance anxiety and who are contraindicated?

Answer 66

atenolol, propanolol- asthma severe bronchorestriction

Question 67

SNRI or SSRI for SAD?

Answer 67

SSRI first

Question 68

What are the 6 stages of PTSD?

Answer 68

freeze, flight, fight, fright, flag, faint

Question 69

What happens with long term stress or high stress situations?

Answer 69

breaks down ability for brain to consolidate memories

Question 70

What are criteria for PTSD?

Answer 70

experience reexperience avoidance

Question 71

What is nonpharm for PTSD?

Answer 71

TAILORED on trauma focused psychotherapy

Question 72

What first line for PTSD?

Answer 72

Fluoxetine, paroxetine, sertraline venlafaxine prazosin

Question 73

What drugs are NOT recommended in PTSD? WHY?

Answer 73

BENZOS - no efficacy and more harms

Question 74

Which SSRI has most sex dysfunction?

Answer 74

sertraline

Question 75

When to see onset, max response and duration for PTSD?

Answer 75

onset 2-8 weeks max-12 weeks duration 1-2 years

Question 76

What is diagnosis of OCD?

Answer 76

recurrent thoughts and urges behaviours to prevent or reduce anxiety

Question 77

What can cause OCD?

Answer 77

genetic, streptococcal infection pregnancy, abuse

Question 78

What is first line for OCD?

Answer 78

SSRI (escitalopram, fluoxetine, paroxetine, sertraline) for minimum 12 weeks and CBT for 13 sessions

Question 79

What other Nonpharm for OCD?

Answer 79

deep brain stimulation- severe radio frequency wave surgery- refractory

Question 80

Which is CBT better for obsessions or compulsions?

Answer 80

compulsions