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Anxiety Flashcards

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1
Q

First Line Treatment for Generalized Anxiety Dx….

A

SSRI OR SNRI

Duloxetine
Escitalopram
Paroxetine
Sertraline
Vanlafaxine
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2
Q

Duloxetine

A

Cymbalta
SNRI
30mg

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3
Q

Escitalopram

A

Lexapro
SSRI
10 mg

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4
Q

Paroxetine

A

Paxil
SSRI
20 mg

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5
Q

Sertraline

A

Zoloft
SSRI
1st line agent but doesnt say “FDA approved”
50mg

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6
Q

Venlafaxine XR

A

Effexor
SSRI
37.5 mg

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7
Q

How long to trial a drug before assessing for response…

A

4-6 weeks

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8
Q

BENZOS FOR ANXIETY DX…

A 
Alprazolam (XANAX)
Chlordiazepoxide (LIBRIUM)
Clonazepam (KLONOPIN)
Clorazepate (TRANXENE)
Diazepam (VALIUM)
Lorazepam (ATIVAN)
Oxazepam (SERAX)
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9
Q

Alprazolam

A

XANAX

Anx, Anx w/depression, Panic Disorder

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10
Q

Chlordiazepoxide

A

LIBRIUM

Anx, Pre-op anx, Alcohol withdraw

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11
Q

Clonazepam

A

KLONOPIN

Anticonvulsant, Panic dx

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12
Q

Clorazepate

A

TRANXENE
Anx, Alcohol withdraw, Anticonvulsant
PRODRUG

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13
Q

Diazepam

A

VALIUM

Anx, muscle rlx, Alcohol withdraw, preop anx, anticonvulsant

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14
Q

Lorazepam

A

ATIVAN

Anx, Anx/depression, anticonvulsant, premed anesthetic

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15
Q

Oxazepam

A

SERAX

Anx, alcohol withdraw

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16
Q

Metabolism through Oxidation can be impaired by what patients…

A

Liver Dx
Elderly
Those taking meds that inhibit oxidation–>Increase levels of the drug

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17
Q

Benzos with Oxidation mets…

A

Alprazolam (XANAX)
Clorazepate(TRANZENE)
Diazepam (VALIUM)

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18
Q

Quick Onset Short acting Benzos…

A

Diazepam (VALIUM)

Clorazepate (TRANXENE)

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19
Q

Slower Onset but Longer acting Benzos…

A

Oxazepam (SERAX)

Lorazepam (ATIVAN)

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20
Q

Benzo you should not give IM

Benzo you SHOULD give IM

A

Diazepam

Lorazepam

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21
Q

Aging on Benzos…

A

Longer elimination half life–>Lower dosing, less frequent dosing
Decreased clearance w/oxidation–>PREFERRED LORAZEPAM AND OXAZEPAM in elderly
Decreased plasma proteins lead to increased Free fraction benzos–>Increased effects
Decreased gastric acidity–>Increased rate Benzo absorption

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22
Q

Gender on Benzos…

A

ELDERLY MEN MAY REQUIRE ESPECIALLY LOW BENZO DOSE
Possible decrease in plasma conc with oxidative metabolism in premenopause women
WOMEN HAVE LONGER ELIMINATION OF LORAZEPAM AND TEMAZEPAM AND MAY NEED LESS FREQUENT DOSING
Greater drug accumulation

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23
Q

Risk factors for withdrawal seizures…

Study These Flashcards
A

High Benzo Doses
Long duration of therapy
Concurrent ingestion of drugs that decrease seizure threshold

24
Q

TAPERING REGIMINE

Option one

Study These Flashcards
A
  • 25% week reduction in dosage until 50% of dose

- Decrease by 1/8 every 4-7 days

25
Tapering: If youve been on benzos more than 8 weeks
Slow taper over 2-3 weeks
26
Tapering: Duration 6 months or longer
Taper 4-8 weeks
27
Tapering: Long term use over 1 year
2-4 months taper
28
Adjuncts to Help with Withdraw from Benzos....
PREGABALIN (LYRICA) Psychotherapy interventions with tapering lead to superior outcomes
29
Buspirone brand and info
Buspar - Anxiolytic with delayed onset of action need at least 2-4 weeks for efficacy - Monotherapy option for GAD especially uncomplicated, failed therapies, and substance abuse - May be initiated before Benzo taper because it may ease withdrawal
30
Important CAUTION for Buspirone...
- Safe profile, large increase in concentration may be clinically insignificant - AVOID IN MAOIS - CAREFUL WITH HIGH DOSE ANTIDEPRESSENTS BECAUSE OF SEROTONIN SYNDROME Grapefruit juice and CYP3A inhibitors increase conc. *DECREASE DOSE FOR RENAL OR HEPATIC IMPAIRMENT
31
Alternatives to treatment.....
Hydroxyzine Pregabalin Atypical Antipsychotics
32
Hydroxyzine
Vistaril Used in a primary care setting GAD for Kids w/anxiety and tension
33
Pregabalin
Lyrica RENAL ADJUST Similar effect of Lorazepam, Alprazolam, and Venlafaxine
34
Quetapine XR
Seroquel XR MONOTHERAPY As effective as Paroxetine and Escitalopram Earlier onset of action BUT NOT FDA APPROVED FOR GAD
35
Drug may be more likely to cause weight gain and should be avoided in preggo...
Paroxetine (PAXIL)
36
SSRI that needs a ECG baseline...
Citaloprim (CELEXA)
37
Paradoxical Disinhibition is what? and What population does it usually occur in and what meds?
Increased anxiety, irritability, or agitation In Elderly and Children ON BENZOS
38
Common Side effects of SSRIs Escitalopram Paroxetine Sertraline
``` Jitterness Syndrome Suicidality NVD Weight Gain Sexual dysfunction Hyponatremia Teratogenicity--PAROXETINE cat D DC sydrome ```
39
Common SE of Benzos..
``` Drowsiness/Fatigue ANTEROGREAE AMNESIA & MEmory impairment--ESPECIALLY WITH ALCOHOL Dependence Withdrawl symptoms Respiratory Depression Psychomotor Impairment Paradocial Disinhibition ```
40
Pregabalin ADRs
``` Orthostatic Hypotension Dizziness Peripheral Edema Thrombocytopenia Weight Gain ```
41
GAD in special Pops (Substance abuse, preggo, children, elderly)
Fluoxetine Sertraline Citalopram
42
Benzos with Pregnancy....
AVOID in 1st trimester-if necessity, lowest dose shortest period of time. Cause: Cleft lip, palate, etc. 3rd trimester: Sedation, Withdrawal, Floppy Baby Syndrome (Hypotonia, low apgar scores, Hypothermia) DIAZEPAM AND CHLORDIAZEPOXIDE DOC IF HAVE TO HAVE ONE DURING PREGGO
43
Do not use these Benzos when Nursing...
Diazepam and Clonazepam
44
Patients with what are at risk for accumulation of Benzos?
Hepatic Impairment
45
Avoid this SNRI in Hepatic Impairment....
Duloxetine (CYMBALTA)
46
Definition of Treatment Resistance....
Poor, partial, or lack of response with at least two antidepressants from different classes
47
Strategies for pts who dont achieve appropriate response with 1st line agent...
``` Increase dose of SSRI/SNRI Change to diff agent in same class Change to diff agent in diff class Augmentation of therapy ```
48
Sexual Dysfunction is an AE for what drugs...
Paroxetine and Escitalopram Slight chance of Venlafaxine
49
Increased Sweating could be experienced with...
Paroxetine, Duloxetine, Maybe Venlafaxine
50
Agoraphobia
Anxiety disorder when a patient fears and avoids paces or situations that might cause panic and feelings of being trapped, helpless, or embarrassed
51
Benzos for Panic Dx...
Alprazolam and Clonazepam
52
FOR PANIC DISORDER...Benzo treatment regimen
SHORT TERM 4-6 weeks addition of alprazolam or clonazepam with antidepressents produces a better response but DC BZD by week 7 of therapy
53
Recommended BB as an adjunctive tx with SSRI for tx resistant Panic Disorder...
PINDOLOL
54
LESS AGGRESSIVE TAPERING OF BENZOS IN PANIC DISORDER...
Slow and gradual tapering over 2-4 months no more than 10% decrease per week.
55
Social Anxiety disorder is treated in phases....
Acute Phase 4-12 weeks-->reduce symptoms, and phobic avoidances Continuation Phase-->3-6 months Extend benefits and improved QOL
56
Patients with SAD response....
Slow response and less completley
57
Treatment that can help SAD AND Pts with Alcohol dx...
Paroxetine (PAXIL)

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