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Pharm3- fixed > Anxiety-Test 2 > Flashcards

Anxiety-Test 2 Flashcards

1
Q

What is a sedative?

A

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

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2
Q

What is a hypnotic?

A

A drug that produces sleep by depressing brain function

Often cause hangover effects in the morning

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3
Q

What is an anxiolytic?

A

Drug that reduced anxiety

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4
Q

What is anxiety commonly caused by?

A

the perception of real or potential danger

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5
Q

What general medical conditions can cause anxiety?

A

MI, asthma, hyperthyroidism, migraine, pain

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6
Q

What psych disorders can cause anxiety?

A

Mood disorders, schizophrenia, delirium, dementia, substance abuse

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7
Q

What medications can induce anxiety?

A

Depressants and stimulants

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8
Q

When does anxiety become pathological?

A

Pathological anxiety occurs when safe stimuli acquire a meaning of danger

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9
Q

When does anxiety become a disorder?

A

when source of significant subjective distress or functioning impaired

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10
Q

What are the neurochemical theories behind anxiety?

A

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

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11
Q

What is the MOA of benzos?

A

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

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12
Q

What are the anxiety disorders?

A 
Panic Disorder 
Panic Attacks
Social Anxiety Disorder (SAD)
Specific Phobia
Generalized Anxiety Disorder (GAD)
Obsessive-compulsive Disorder (OCD)
Posttraumatic Stress Disorder (PTSD)
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13
Q

What is classic presentation of a panic attack?

A

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

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14
Q

What is generalized anxiety disorder?

A

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

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15
Q

What s/s of GAD?

A 
3 or more symptoms:
-Restlessness
-Easily fatigued
-Difficulty concentrating
-Irritability
-Muscle tension
-Sleep disturbance
also sig distress at work and socially 
somatic complaints common
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16
Q

What are the nonpharm options for tx of GAD?

A

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

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17
Q

What are drug options for tx GAD?

A

Antidepressants, benzos, buspirone, pregabalin, beta blockers

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18
Q

What are the benzos?

A

Pams

19
Q

What are benzos good for?

A

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

20
Q

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

A

Clorazepate
Chlordiazepoxide
Diazepam
Flurazepam

21
Q

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

A

Alprazolalm
Lorazepam
Temazepam

22
Q

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

A

Oxazepam

Triazolam

23
Q

What is the MOA of benzos?

A

Potentiate the inhib activity of GABA

24
Q

What are the ADRs of benzos?

A

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

25
Q

What is the taper plan for d/c benzos?

A
26
Q

What do benzos interact with?

A

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
Q

What are disadvantages of using benzos?

A

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

28
Q

What are s/s of benzo withdrawal?

A

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

29
Q

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

A

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

30
Q

What affects do BBlockers have in controlling anxiety?

A 
Physiologic component of anxiety:
ltachycardia, palpitations, tremor, sweating
No CNS depression 
lnon-addicting, no drowsiness
Helpful for performance anxiety:
lpropranolol 10 mg prn
31
Q

When should you not use Bblocker?

A

Do not use in asthma, diabetes, CHF

lmonitor BP, pulse

32
Q

What is the MOA of buspirone?

A

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

33
Q

What are the advantages of using buspirone?

A

Dependence unlikely; minimal sedation

34
Q

What are the disadvantages of using buspirone?

A

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

35
Q

What are the ADRs of buspirone?

A

HA, dizzy, nausea

36
Q

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

A

1 week with max effect at 4-6

37
Q

How is buspirone dosed?

A

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

38
Q

What is the MOA of pregabalin?

A

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
Q

What are the ADRs of pregabalin?

A

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

40
Q

What are the tx principles for GAD?

A

SSRI is first line

41
Q

What is the tx of choice in panic disorder?

A

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

42
Q

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

A

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

43
Q

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

A

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

Pharm3- fixed (12 decks)

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