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Flashcards in Anxiety Deck (25):
1

Who is most at risk of anxiety?

Women
Whites
30-40s

2

Anxiety Rating Scales

HAM-A
SAS
STAI

3

GAD Dx Criteria

General anxiety for >6 months + 3 of 6 other sx (fatigue, restless, irritable, pain etc)
Distress/impairment

4

First Line Treatment of GAD

SSRIs - start at 1/2 dose to avoid rebound anxiety
Reassess after 4 week trial

5

SSRI Side Effects

GI upset - goes away
Loss of libido
Weight gain
SR Syndrome

6

Which SNRIs are first line for GAD?

Duloxetine and Effexor XR
Hi doses = NE activity

7

Second Line GAD

TCAs
BZDs
Buspirone
Lyrica
Vistaril
Benadryl

8

TCA Side Effect Profile

Cardiac complications
Suicide
Anti-Ach effects!

9

BZDs in GAD

Not recommended as mono therapy - dependence/tolerance
Require GABA to be bound, to have effect!

10

Which BZDs have active metabolites?

Chlordiazepoxide - oldest
Diazepam

11

Which BZD has the worst withdrawal effects?

Oxazepam

12

Which BZDs can be given in hepatic dysfunction?

Lorazepam
Oxazepam
Temazepam
Not metabolized by p450s!

13

Short and Long Term Considerations in BZDs in GAD

Short - rebound anxiety
Long - amnesia, dependence

14

Stopping BZDs

Taper by 10% every 2-3 weeks and monitor for GAD/withdrawal sx

15

Buspirone

SR autoreceptor blockers
Onset 4-6 weeks

16

Lyrica in GAD

Basically 3rd line because not a thing
Not robust enough evidence

17

Anti-His in GAD

Sedation purposes only
NOT for severe GAD
PRN/adjunct

18

Panic Disorder w/o Agoraphobia Dx Criteria

Panic attacks + 1+ months of worrying about attacks (future occurrences, implications, ∆behavior)

19

PD w/ Agoraphobia Dx Criteria

Panic attacks + 1+ months of worrying about attacks (future occurrences, implications, ∆behavior)
PLUS
Anxiety of being in place where escape is impossible/embarrassing - avoided or endured w/ distress

20

Who had PD commonly?

Women
MDD
Alcohol Dependence

21

Which SSRIs have the worst d/c syndrome?

Paroxetine
Cymbalta
Effexor

22

Panic Disorder First Line

SSRIs

23

Panic Disorder Second Line

SNRIs - effexor XR only (IR - somatic sx, anxiety issues)
BZDs
TCAs

24

Social Phobia

INTENSE fear of social/performance sitch - humiliation/embarrassment
Insight
If 6 months

25

Social Phobia Treatment

SSRIs - not Paxil even though it was the first one to be approved by FDA
Effexor XR (2nd line)
BZDs - adjunct to SSRIs
Propranolol