anxiety and ADHD Flashcards
(41 cards)
1
Q
indications for bzd
A
- anxiolytic
- muscle relaxant
- anticonvulsant
- sedative- hypnotic
2
Q
how do bzds work
A
- enhance GABA
- cross reacti with etoh
3
Q
list the bzd drugs
A
- triazolam
- clonazepam
- alprazolam
- lorazepam
- diazepam
- oxazepam
- chloriazepoxide
4
Q
bzd ADRs
A
- sedation
- cognitive impairment- permanent
- ataxia/ incoord- esp in elderly
- respiratory distress
- anterograde amnesia
- paradoxical agitation- high doses
5
Q
bzd withdrawal
A
- much more severe than SSRIs
- occurs after 2 weeks of use
- insomnia
- rebound anxiety
- seizures
- disinhibition in pts predisposed
6
Q
what is a sign of bzd abuse
A
- dose escalation
- do not dev tolerance to anxiolytic or muscle relaxant effects
7
Q
how should to taper to d/c long term bzds
A
- slowly reduce dose over 3-6 months
- start initiating SSRI/ SNRI for anxiety
- consider melatonin for sleep
- consider pregabalin for withdrawal/ anxiety/ sz if taper is fast
8
Q
generalized anxiety disorder (GAD)
A
- constant low level of anxiety
- often comorbid with MDD
- higher rates of CVD and IBS
- females > males
9
Q
tx options for acute GAD
A
- SSRI**
- TCA
10
Q
tx options for maintenance of GAD
A
- SSRI**
- SNRI
- busprione
- can consider pregabalin but high abuse risk
11
Q
what SSRI has best initial response for anxiety
A
- fluoxetine
12
Q
what SSRI has best tolerability for anxiety
A
- sertraline
- preferred as first line
13
Q
buspirone
A
- brand: buspar
- 5HT1a partial agonist
- no sedation, cognitive impairment, respir depression, dependence, or withdrawal like with BZDs
- lacks abuse potential
14
Q
panic attack
A
- pd of intense fear in which sx dev abruptly
- reach peak within minutes
- fearful for life
15
Q
acute phase tx for panic attack
A
- SSRI*
- TCA
- venlafaxine
- BZD for break through if pt has been edu on prodromal sx
16
Q
ppx of panic attacks
A
- SSRI*
- TCA
17
Q
misc. anxiolytic drugs
A
- antiepileptics
- atypical antipsychotics
- hydroxyzine
- propranolol
- clonidine
18
Q
antiepileptics as anxiolytics
A
- used for GAD only
- not strong enough for panic
- not as well tolerated or as effective as serotonin agents
- pregabalin, gabapentin
- tiagabine
- topiramate
19
Q
atypical antipsychotics as anxiolytics
A
- only as add on to SSRI for panic
- NOT to be used in GAD
20
Q
causes of ADHD
A
- genetic
- reduced DA and NE
- leads to delayed brain maturation by 2-3 years, catch up by about 18
21
Q
methylphenidate and dexmethylpenidate
A
- stimulants
- mainly impacts DA, less impact on NE
- quick onset within first day
- avail as many dif forms- avoid transdermal patch
- NO impact on tics
22
Q
amphetamines
A
- stimulants
- mainly impacts NE, some DA, MAO, alpha and beta
- quick onset within first few days of dosing
- avail as many dif dosing forms
- may worsen preexisting tic or dev new onset tic
- more risk of drug interactions
23
Q
ADRs of stimulants
A
- insomnia
- reduced appetite
- stomach ache
- HA
- irritability
- generally less ADRs with extended release
- low increase in HR and BP- monitor at each visit
24
Q
how is dosing preferred for stimulants
A
- QD with longer acting agents
- may add short acting agent for intermittent evening activities
25
what disease states should you be cautious using stimulants in
- CVD
- psychosis
- glaucoma
26
stimulants and CV risk
- untreated ADHD more likely to abuse cigarettes and substances
- stimulants dont show worsened CV risk
27
simulants and seizures
- NOT a c/i to use
| - best data to support methylphenidate
28
what impact does DA have on ADHD sx
- dont pay attention to distractions around you
29
what impact does NE have on ADHD sx
- increased attention to task
30
stimulant risk of abuse
- kids with ADHD more likely to have an abuse problem than those without
- BUT kids adequately treated with stimulant for ADHD have same abuse rates as non ADHD kids
31
stimulant effect on growth
- 2 cm shorter and 2.7 kg lighter at 3 years
- no difference by ten years
- most effect in first few mo
- consider d/c on weekends and summer
32
atomoxetine
- blocks reuptake of NE, small increase in DA
- quick onset, can have cont improvement for up to 6 weeks
- intial slowed growth but no dif by 36 mo
- usu dosed qAM but may need afternoon dose
33
ADRs of atomoxetine
- GI upset
- dry mouth
- reduced apetitie
- insomnia
- erectile dysfunction
34
drug interactions of atomoxetine
- MAOIs
- SNRIs
- alpha 1 antagonists
- vasoconstrictors
- albuterol
35
stimulants vs atomoxetine
- stim ave small efficacy advantage
- atomoxetine safter for pts with SUD
- atomoxetine may be better for ADHD + anxiety
36
guanfacine
- alpha 2 agonist
- overall not as effective as stimulants
- can be useful adjunct
- takes 4 weeks for full effect
- safe in tics
- consider for comorbid oppositional defiant disorder or conduct disorder
37
ADRs of guanfacine
- decreased BP and HR
- sedation
- somnolence
- fatigue
38
clonidine
- similar to guanfacine but less specific
- greater decreased in BP
- shorter half life
39
what drugs is preferred in tics + ADHD
- methlyphenidate first line
| - alpha 2 agonists reduce tics but not as effective for ADHD
40
what ADHD drugs worsen tics
- amphetamines
41
what ADHD drugs have no effect on tics
- atomoxetine
