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Flashcards in Anxiety Deck (50)
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1

What are the risk factors for anxiety?

- Women - Age: develops prior ro age 30 - Family history of anxiety or depression - Life stressors

2

Pathophysiology of Anxiety?

- Abnormal NT functioning in the amygdala, GABA, NE, Serotonin - Corticotrophin releasing factor - Cholecystokinin - Glutamate - Substance P

3

Classifications of anxiety

- Generalized anxiety disorder - Panic disorder - Social anxiety disorder - Obsessive-compulsive disorder - Post traumatic stress disorder - Specific phobias

4

Nonpharm treatment of Anxiety?

- Psychotherapy - Cognitive behavioral therapy - Meditation - Exercise - Avoid caffeine, stimulants, diet pills, or other meds that cause anxiety - Identify and remove causes of anxiety

5

Pharmacologic treatment of anxiety

- Antidepressants SSRI, ANRIs, TCAs - Benxodiazepines - Buspirone - Hydroxyzine - Pregabalin

6

GAD 1st and 2nd line?

1st: SSRIs/SNRIs 2nd: Benzos as needed, buspirone

7

Panic disorder first line?

SSRIs may need scheduled benzos for 2-4 weeks May need PRN benzo for attacks

8

OCD? 1st line and 2nd line?

1st: SSRIs (high dose) or CBT or both 2nd line: Clomipramine or antipsychotic augmentation

9

Social anxiety 1st and 2nd line

1st SSRI/ SNRIs 2nd: Benzos Beta blockers for performance anxiety

10

PTSD 1st line? Adjunctive agents? What not to give?

1st SSRIs, SNRIs, Add Prazosin or antipsychotic or mood stabalizer No benzos

11

Specific phobia treatment?

CBT

12

SSRIs first line for GAD, PD, OCD, Social anxiety, PTSD

- Start at a lower dose - Can initially cause anxiety - Slower onset than benzos - Need higher dosages for OCD

13

You need a higher when starting an SSRI with what disease?

OCD

14

Escitalopram is approved for the treatment of? 

Approved for GAD 

15

Fluoxetine is approved for?

 approved for PD

16

Fluvoxamine approved for the treatment of? 

OCD

17

Paroxetine approved for the treatment of? 

 treatment of GAD, OCD, PD, PTSD, SAD

18

Sertraline Approved for the treatment of?

treatment of OCD, PTSD

19

Venlafaxine XR approved for the treatment of? 

 GAD and SAD

20

Duloxetine treatment of? 

GAD 

21

What are the SEs of SSRIs?

S-Stomach (N/V/D) S- Sexual dysfunction R- Restlessness, Jitteriness I- Insomnia Headache, Weight gain, withdrawal from abrupt discontinuation

22

Antidepressant tips - If one SSRI/SNRI is ineffective what should be done? - Patients often become tolerant to what? - These medications require? - How many weeks does it take to see response? - When you stop an SSRI how do you do it?

- You should try another one - SEs usually stop within a few weeks expect for Sexual Dysfunction - These require daily administration - Often take 4 weeks or more to see effect - Upon discontinuation you have to taper

23

Benzo are ___ line or adjunct for? Most effective for? Shouldnt be used to treat?

2nd line for anxiety Most effective for acute symptoms Not effective for OCD or PTSD

24

What benzos have a very fast onset?

Alprazolam, Diazepam (super fast)

25

LOT what are the drugs and what are they good for?

Temazepam, Lorazepam, Oxazepam Good for the liver Little to no CYP metabolism

26

Benzos with slow onset?

Oxazepam, Clonazepam, Lorazepam

27

Im administration what benzo?

Lorazepam

28

Most benzos are substrates for?

CYP3A4

29

Substrate of 2C19

Diazepam

30

Inhibitors of CYP3A4

Amiodarone, Azoles, AIDS protease inhibitors, Cimetidine, Ciprofloxacin, Clarithromycin/Erythromycin, CCBs (Diltiazem/Verapamil) Fluvoxamine, Grapefruit, Nefazodone