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Therapeutics III > Anxiety - Block 3 > Flashcards

Anxiety - Block 3 Flashcards

1
Q

Uncomfortable feeling of vague fear or apprehension accompanied by characteristic physical sensations

A

Anxiety

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2
Q

What are the types of ax disorders?

A
  1. Panic Dx
  2. OCD
  3. PTSD
  4. Phobias
  5. GAD
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3
Q

What is the first diagnostic step of diagnosing ax?

A

Consider the possible differential diagnoses such as med conditions/meds

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4
Q

What is the diagnostic criteria for GAD?

A

6 months or more of excessive worry or anx with unidentified cause

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5
Q

What are the assessment tools for GAD?

A

Generalized Anxiety Disorder 7-Item scale (GAD-7)
Penn State Worry Questionnaire

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6
Q

What is the scores associated with GAD7?

A

Greater than 10: GAD
5,10, 15: mild, moderate, severe

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7
Q

Penn State Worry Questionnaire scores?

A

Low: 16–39
Moderate: 40–59
High: 60–80

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8
Q

What are somatic sx of ax?

A
  • Muscle aches/tension
  • HA
  • Backaches
  • GI issues
  • Sleep problems
  • Fatigue
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9
Q

Psychological tx for ax?

A
  1. CBT
  2. relaxation therapy, stimulus control
  3. Cognitive restructuring
  4. Self monitoring
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10
Q

How do we determine what therapies to use?

A
  1. Sx intensity and duration
  2. Imapct of patients ability to function in daily life
  3. Comorbid conditions such as depression
  4. Medical condition
  5. Patient preference
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11
Q

What are the pharm first lines for GAD?

A

SSRI:
* Paroxetine
* Escitalopram
* Sertraline
* Fluoxetine

SNRI:
* Venlafaxine XR
* Duloxetine

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12
Q

What are the second line agents for GAD?

A

BZD:
* Diazepam
* Alprazolam
* Lorazepam
* Clonazepam

TCA:
* Imipramine

Buspirone
Hydroxyzine

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13
Q

What do you do if a patient has a poor response to tx?

A

Change to another AD (SSRI or SNRI)

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14
Q

What do you do if a patient has a partial response to tx?

A
  • Can augment first antidepressant with buspirone,hydroxyzine, pregabalin, or short course of BZD
  • change toanotherantidepressant
  • add CBT, depending on clinical and patientpreference
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15
Q

How do you initiate SSRI/SNRI for anxiety?

A

Start half the initial dose of depression and titrate slowly to minimize anxiousness and jitteriness which can occur during the first 2 weeks of therapy

6-8 weeks to see effect after patient reaches therapeutic levels

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16
Q

How long does it take Buspirone to work?

A

2-4 weeks

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17
Q

Why is TCA second line?

A

Anticholinergic ADRs limit use

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18
Q

What are the 5 effects of BZD?

A

anxiolytic, anticonvulsant, muscle relaxing, and sedative-hypnotic,amnesic actions

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19
Q

How should you administer BZD?

A
  1. Dependence after >6 wks
  2. Potential for abuse or dependence
  3. Abrupt cessation can lead to withdrawal
  4. Treatment period should be limited to 1-2 weeks
  5. Requires tapering if been on for a long time
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20
Q

What are common withdrawal sx from BZD?

A

Seizures, psychotic rx

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21
Q

What are the recommendations for tapering BZDs?

`

A
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22
Q

BZD with short half life and high potency are indicated for?

A

Quicker contol of sx -> acute management that is eventually replaced with long acting agents

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23
Q

BZD with long half life and low potency are indicated for?

A

Interdose breakthrough symptoms are less likely, however, can cause hangover sx
* Accumulation in older adults

24
Q

BZD with short half life? long?

A

SHort: Alprazolam, Lorazepam
Long: Chlordiazepoxide, clonazepam, clorazepate and diazepam

25
Q

What BZD have low hepatic metabolism and have no active metabolites?

A

Lorazepam, oxazepam and alprazolam

26
Q

What BZD has the most rapid onset but greatest abuse potential?

A

Diazepam and clorazepate

27
Q

Describe the progressions of BZD effects as dose increases?

A
28
Q

Most common BZD for anxiety?

A

CLAD- Clonazepam, Lorazepam, Alprazolam, Diazepam

29
Q

BZD commonly used for alcohol withdrawal?

A

ordiazepoxide,Diazepam, Lorazepam

30
Q

BZD used to control sz?

A

Diazepam

31
Q

What BZD formulation is used for anxiety?

A

short acting with high potency acutely or max 1-2weeks

32
Q

CI of BZDs?

A
  1. Elderly
  2. Substance and alcohol abuse history
  3. Chronic opiods
  4. Pregnancy (cleft lip)
33
Q

BZDs safe for elderly?

A

Lorazepam, Oxazepam, Temazepam

34
Q

Alprazolam CI?

A
  1. Acute narrow angle glaucoma
  2. Ketoconazole, itraconazole, CYP3A4 inhibitors
35
Q

Diazepam CI?

A
  1. Untreated open angle glaucom
  2. Infants <6 months
  3. Myasthenia gravis
  4. Severe respiratory impairment
  5. Sever hepatic impairment
  6. Sleep apnea syndrome
36
Q

What is the BBW for BZDs?

A

Avoid conmitant use with opioids -> respiratory depression and death

37
Q

ADR of BZD?

A

CNS depression: : fatigue,drowsiness, muscle weakness, ataxia
Respiration: resp depression
CV: orthostatic hypotension, tachycardia

38
Q

What are alternatives for anxiety?

A

Hydroxyzine: short term, anticholinergic effects
Pregabalin: immediate anxiolytic effectsm C-V, used for neuropathic pain
Beta blockers: Propranolol

39
Q

OTC products for anxiety?

A
  1. St johns worts
  2. SAM-e
  3. Folate
  4. Omega 3
40
Q

Tx for OCD?

A

Non-Pharm: behavioral therapy
Pharm: SSRI and SNRI, BZ, Buspirone, TCA
Effective if patient does both
Last resort: Neurosurgery, ECT

41
Q

Causes of OCD?

A

Serotonergic dysfunction
Neurology problem
Genetics

42
Q

How long does it take OTC tx to work?

A

4-12 wks

43
Q

What class of drugs fail to control OCD completely?

A

SSRI

44
Q

What is the only effective TCA for OCD?

A

Clomipramine

45
Q

What are the augemnetation agents for OCD?

A

Haloperidol
SGA: olanzapine, quetiapine, risperidone

46
Q

How long does it take for PTSD tx to work?

A

8-10 weeks

47
Q

How long of PTSD patients on treatment for?

A

12-24 months for 75% reduction of sx for 3 months

48
Q

First line for PTSD

A

SSRI: fluoxetine, sertraline, and paroxetine

49
Q

Augemtation therapy for PTSD?

A

antiadrenergic – prazosin- PTSD associated with nightmares
Anticonvulsants-valproic acid, carbamazepine, lamotrigine, topiramate-PTSD associated with aggression, anger, depression
anxiolytics (no benzo), buspirone
Antipsychotics-olanzapine, quetiapine, risperidone- PTSD associated with psychotic symptoms
β-blockers or mood stabilizers- in intermittent explosive behavior
BDZ are acutely used for sleep disturbances, should be very limited

50
Q

What are specific phobias?

A

fear of objects or situations:
1. Animals
2. Blood injection type
3. Natural environment
4. Situational
5. Other

51
Q

What is the tx for phobias?

A
  1. CBT
  2. Avoidance
  3. No meds
  4. Systematicdesensitization
52
Q

Nonpharm tx for social phobias?

A
  1. Psychotherapies
  2. Exposure
  3. Social skills training
  4. Cognitive behavioral therapy
53
Q

How long is the onset of AD for social phobia tx?

A

12 weeks

53
Q

What are the pharm tx for social phobias?

A

First line: SSRI (escitalopram, fluvoxamine, paroxetine, sertraline) andvenlafaxine
Second/third: Gabapentin and pregablin
Adjunct: Clonazepam
Other: Benzos, beta blockers, MAOI

54
Q

What are the target sx of panic dx?

A

Chest pain, SOB, DZ, depersonalization

55
Q

Tx for panic disorders?

A

Non pharm: CBT
First line: SSRI (escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline)
* SNRI: venlafaxine, and duloxetine

Other: BZD, alprazolam, lorazepam, clonazepam
Higher doses than in GAD , use lowest effective dose

56
Q

What are not effective agents for panic disorders?

A
  1. Buspirone
  2. B-blockers
  3. Antihistamines
  4. Antipsychotics
  5. Bupropion
  6. Trazodone

Therapeutics III (40 decks)

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