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PMHNP > Anxiety Disorders > Flashcards

Anxiety Disorders Flashcards

1
Q

Anxiety sx

A

Worry
panic attacks
phobic avoidance
compulsions
muscle tension
irritability
sleep
concentration
fatigue

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2
Q

Anxiety patho amygdala

A

Integrates sensory and cognitive information to determine fear response

Emotions
Motor responses
Endocrine reactions
Autonomic responses
Anxiety

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3
Q

Noradrenergic model of anxiety

A

ANS is hypersensitive to threat or fear

Locus Coeruleus: Alarm center
so
NE release
so
Stimulate SNS and PNS

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4
Q

GABA Receptor model of anxiety

A

GABA is the major inhibitory NT

Strong regulatory effects:
serotonin
norepinephrine
dopamine

Benzodiazepine ligands enhance the inhibitory effects of GABA

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5
Q

Serotonin Model of anxiety

A

Serotonin primarily an inhibitory NT

Serotonin activity reduces norepinephrine activity from the locus coeruleus

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6
Q

SSRI and SNRI action as tx for anx

A

SSRI
* Inc 5ht and dec NE which may help regulate anx

SNRI
* inc NE which means initially people may inc anx but in long term may dec. That’s why low and slow start

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7
Q

BZD as tx for anx

A

BZD bind to receptors ro inhibit NT release

BZD and Gaba A bind together to inc the Chloride channel even more

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8
Q

Buspirone as tx for anx

A

5HT1A receptor partial agonist

  • Pre and post synapse receptor
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9
Q

Gabapentin and pregabalin as tx for anx

A

They block glutamate when its excessive

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10
Q

Anxiety Tx factors in decision making

A

age
previous tx response
risks (overdose, self harm)
Rx interaction
patient preference
cost

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11
Q

Panic Disorder DSM

A

Recurrent unexpected panic attacks

followed by 1+ mo of
-persistent concern about additional attacks
Maladaptive changes in behavior to avoid attacks

Not r/t SUD or other dx

Disturbance is not better explained by another mental disorder

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12
Q

1st line tx panic disorder (class)

A

CBT
SSRI
SNRI

some guidelines say TCA, BZD too

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13
Q

SSRI and SNRI tx for panic (PROS)

A

decent safety profile
no major difference b/t agents

fluoxetine, sertraline, paroxetine FDA approved

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14
Q

SSRI and SNRI tx for panic (CONS)

A

poss inc at first in anx, agitation, irritability, jittery

Assoc with GI, HA, sex, sleep, HTN

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15
Q

TCA tx for panic (PROS)

A

comparable efficacy to SSRI

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16
Q

TCA tx for panic (CONS)

A

Less tolerated than SSRI

high anticholinergic AE

Cardiac considerations and more lethal in overdose

17
Q

BZD tx for panic (PROS)

A

useful adjunct to tx residual anxiety

preferred for very distressing or impairing sx

rapid anxiety control

18
Q

BZD tx for panic (CONS)

A

combo with opioids

dependence

withdrawal

CNS depression

19
Q

Panic attack tx onset of efficacy
Antidepressants
BZD

A

antidepressants:
-3-4 wks
-pt with significant avoidance, full remission may take 6+ mo

BZD:
onset in hrs for ANS sx of anx
Full benefit 4-6 wks when used as monotherapy

20
Q

Panic attack duration of tx
Acute
Maint
discontinue

A

Acute phase
1-4 mo
Alter tx if no response at 12 wks at max tolerated dose

Maintenance
- minimum 12 mo
- cont if residual sx

Discontinue
- based on sx stability, stressors, motivation
- taper over 4-6 mo to reduce relapse

21
Q

Social Anxiety Disorder DSM

A

Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others

Fear of acting in a way or showing anxiety symptoms that will be negatively evaluated

Social situations almost always provoke fear or anxiety
—-Avoided or endured with intense fear or anxiety

Fear, anxiety, and avoidance are persistent
—->6 months

Significant distress or impairment

Not related to substance use or medical condition

Disturbance is not better explained by another mental disorder

22
Q

1st line tx SAD (class)

A

CBT
SSRI

Some guidelines say SNRI too

23
Q

Rx FDA approved for SAD (SSRI and SNRI)

A

Paroxetine
Sertraline
Venlafaxine

limited evidence for citalopram and escitalopram

24
Q

SAD tx
Sx reduction time
Duration
Taper

A

Sx reduction
- 6-8 wks on tx

After response to prevent relapse
- cont rx for 12 mo

taper
- 3-4 mo

25
Q

GAD DSM

A

Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities

Difficult to control the worry

The anxiety, worry, or physical symptoms cause clinically significant distress or impairment

Not related to substance use or medical condition

Disturbance is not better explained by another mental disorder

26
Q

1st line tx for GAD (class)

A

SSRI

Most guidelines
- SNRI

Some guidelines
CBT
Pregabalin
Buspirone
hydroxyzine

One guideline
TCA
BZD

27
Q

Rx FDA approved for GAD

A

Escitalopram
paroxetine
duloxetine
venlafaxine

small initial daily doses for the first wk
- 50% recc starting dose
- to minimize AE

28
Q

Alt rx for GAD

A

Pregabalin
- short term and long term
- rapid onset efficacy (1 wk)
- similar effect to BZD

Buspirone
- FDA approved and decent for short term
- inconsistent evidence for long term
- Mult AE

Hydroxyzine
- Sx relief of anxiety and tension
- up to 12 wks
- Mult AE though (CNS, psychomotor, anticholinergic)

BZD
-2-3 wks max or until SSRI starts to work
- most common for acute tx r/t rapid relief
- long term not recc

29
Q

onset and duration of tx for GAD

A

antidepressant response
-4-12 wks

with good response
-cont 12+ mo

Discontinue
- gradual d/c to dec risk

Antidepressants and pregabalin shown safe for long term and preferred to dec relapse

PMHNP (24 decks)

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