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Flashcards in Anxiety-Test 2 Deck (43):
1

What is a sedative?

a drug that has a calming effect, relieving anxiety and tension. Sedatives are hypnotic drugs administered at lower doses than those needed for sleep

2

What is a hypnotic?

A drug that produces sleep by depressing brain function
Often cause hangover effects in the morning

3

What is an anxiolytic?

Drug that reduced anxiety

4

What is anxiety commonly caused by?

the perception of real or potential danger

5

What general medical conditions can cause anxiety?

MI, asthma, hyperthyroidism, migraine, pain

6

What psych disorders can cause anxiety?

Mood disorders, schizophrenia, delirium, dementia, substance abuse

7

What medications can induce anxiety?

Depressants and stimulants

8

When does anxiety become pathological?

Pathological anxiety occurs when safe stimuli acquire a meaning of danger

9

When does anxiety become a disorder?

when source of significant subjective distress or functioning impaired

10

What are the neurochemical theories behind anxiety?

The noradrenergic model- hypersensitive ANS
Benzodiazepine receptor model: inhib pathways def in anxiety disorders
Serotonin model- inhib NT may help reduce ANS hyperactive state

11

What is the MOA of benzos?

The binding of benzodiazepines enhances the action of GABA, resulting in a greater entry of chloride ion

12

What are the anxiety disorders?

Panic Disorder
Panic Attacks
Social Anxiety Disorder (SAD)
Specific Phobia
Generalized Anxiety Disorder (GAD)
Obsessive-compulsive Disorder (OCD)
Posttraumatic Stress Disorder (PTSD)

13

What is classic presentation of a panic attack?

Sudden onset with no warning,peak intensity in 10 min ( last only 20-30 min), can occur anytime, there is an overwhelming sense of doom, fear of dying, or fear of losing control accompanied by physical symptoms

14

What is generalized anxiety disorder?

Excessive anxiety and worry about a number of events or activities on most days for at least 6 months

15

What s/s of GAD?

3 or more symptoms:
-Restlessness
-Easily fatigued
-Difficulty concentrating
-Irritability
-Muscle tension
-Sleep disturbance
also sig distress at work and socially
somatic complaints common

16

What are the nonpharm options for tx of GAD?

Lifestyle: avoid caffeine, ETOH in excess or for sleep, OTC cold preps, marijuana
CBT

17

What are drug options for tx GAD?

Antidepressants, benzos, buspirone, pregabalin, beta blockers

18

What are the benzos?

Pams

19

What are benzos good for?

The most effective and safe meds for acute axiety symptoms – rapid onset

20

what are the long acting (1-3 days) benzos?

Clorazepate
Chlordiazepoxide
Diazepam
Flurazepam

21

What are the intermediate acting (10-20hr) benzos?

Alprazolalm
Lorazepam
Temazepam

22

What are the short acting (3-8hr) benzos?

Oxazepam
Triazolam

23

What is the MOA of benzos?

Potentiate the inhib activity of GABA

24

What are the ADRs of benzos?

Sedation, fatigue, weakness, psychomotor impairment, paradoxical reactions, rebound anxiety and insomnia

25

What is the taper plan for d/c benzos?

26

What do benzos interact with?

Other CNS depressants : ETOH
Cimetidine : Inhibits metabolism of longer acting BZDs
Fluoxetine: Decreases clearance of diazepam
CYP3A4 inhibitors (fluoxetine, fluvoxamine, grapefruit juice, ketoconazole, nefazodone): Decrease clearance of alprazolam

27

What are disadvantages of using benzos?

Physiologic dependence, risk for withdrawal if abruptly dc, and concern for over abuse potential

28

What are s/s of benzo withdrawal?

confusion, anxiety, agitation, restlessness, insomnia, tension …short acting more severe

29

What can be given to reverse the effects of benzos in an OD?

Flumazenil…..May precipitate withdrawal in dependent patients or cause seizures in epileptics

30

What affects do BBlockers have in controlling anxiety?

Physiologic component of anxiety:
ltachycardia, palpitations, tremor, sweating
No CNS depression
lnon-addicting, no drowsiness
Helpful for performance anxiety:
lpropranolol 10 mg prn

31

When should you not use Bblocker?

Do not use in asthma, diabetes, CHF
lmonitor BP, pulse

32

What is the MOA of buspirone?

Reduce 5-HT transmission by acting as partial agonist at these receptors

33

What are the advantages of using buspirone?

Dependence unlikely; minimal sedation

34

What are the disadvantages of using buspirone?

Only effective in GAD; doesn’t work in severe anxiety
Slow onset of action
Causes hypothermia; increased prolactin/GH
P450 metabolism

35

What are the ADRs of buspirone?

HA, dizzy, nausea

36

How long does it take for buspirone to have anxiolytic effects?

1 week with max effect at 4-6

37

How is buspirone dosed?

Start around 5mg, add 4 mg every 2-3 days as needed. Usual is 20-45/day, max is 60

38

What is the MOA of pregabalin?

Works on the A2 D subunit of voltage dependent Ca channels…. Reduces Ca influx inhibiting neuronal excitability which reduced the release of glutamate, NE

39

What are the ADRs of pregabalin?

Dizzy, somnolence, dry mouth, abnormal thinking, blurred vision, diarrhea, incoordination, and ataxia

40

What are the tx principles for GAD?

SSRI is first line

41

What is the tx of choice in panic disorder?

SSRI… can combine with BZD for the first few weeks of tx

42

What is a common reaction in panic disorder and a reason for such a high drop out rate in tx studies?

Jitteriness syndrome or hypersensitivity rxn…appears with initial doses , to try to prevent start low and increase slowly

43

What should be the long term maintenance for anxiety disorders following the amelioration of acute symptoms?

GAD: about 1 yr
PD: >/= 1 yr
SP: >/=6 mo