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anxiety therapeutics Flashcards

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1
Q

there are ___ and ___ symptoms in anxiety disorders

A

psychic and somatic

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2
Q

6 potential general options for pharmacotherapy for anxiety

A

benzodiazepines
buspirone
antidepressants
beta-blockers
alpha-blockers
antipsychotics

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3
Q

what is considered 1st line for all anxiety disorders

A

SSRIs/SNRIs

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4
Q

true or false

antidepressants work in the LONG TERM to treat chronic anxiety

A

true

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5
Q

____ may be used short term to manage acute anxiety symptoms

A

benzodiazepines

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6
Q

important note when dosing anxiolytics

A

start low, go slow, and aim high

anxious patients are more sensitive to AE!
also, higher doses are typically required to treat, just want to start low and go slow

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7
Q

4 drugs for the SOMATIC symptoms of anxiety disorders

A

benzos
buspirone
beta blockers
clonidine

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8
Q

5 potential options for the PSYCHIC symptoms of anxiety disorders

A

buspirone
SSRI
SNRI
TCA
MAOI/antipsychotics

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9
Q

only drug that can be used for both the psychic and somatic anxiety symptoms

A

buspirone

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10
Q

“does the patient require immediate treatment?”

explain the yes/no pharmacologic regimen

A

if YES - give BENZOS for 2-4 weeks

then, do nonpharm interventions (problem solving, coping skill, relaxation, breathing techniques)

antidepressants

and reevaluate in 4-6 weeks

if NO - select treatment and do the above ^^

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11
Q

*the goal of chronic anxiety treatment

A

remission!
(70% reduction from baselin)

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12
Q

“response” to anxiety treatment is defined as…

“non-response” is defined as…

A

response - 50% reduction

non-response - less than 25% reduction

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13
Q

when to evaluate an anxiety patient after starting therapy

A

4-6 weeks later

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14
Q

true or false

when a patient is evaluated 4-6 weeks after starting treatment, MUST use a standardized rating scale to see improvement

A

FALSE - can also use just general measures of improvement

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15
Q

the anxiolytic effect of antidepressants starts around how long after starting

A

2-4 weeks

if dont improve after 4 weeks, the likelihood of having a response decreases

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16
Q

a patient starts experiencing the anxiolytic effect of antidepressants within 2-4 weeks after starting

how long should they be continued on therapy and why

A

at least 1 year

to reduce the chance of relapse

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17
Q

true or false

anxiolytics can be abruptly dicontinued

A

FALSE - avoid this. gradually taper

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18
Q

if a patient responded to an anxiolytic, is tapered off, and then relapses, what should be done?

A

may continue the treatment forever

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19
Q

2 things that are considered 1st line for GAD

A

SNRI/SSRI

benzodiazepine (only as short term bridge)

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20
Q

5 things that are considered 2nd line for GAD

what is 3rd line

A

2nd - buspirone, bupropion (controversial), TCA, quetiapine, pregabalin

3rd - MAO inhibitor

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21
Q

true or false

SSRI/SNRI are effective for cognitive symptoms such as worry

A

true

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22
Q

true or false

SSRI/SNRI have high abuse potential

A

FALSE - lack of abuse. this is a advantage

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23
Q

true or false

a benefit of SSRI/SNRI is that long term treatment maintains remission and prevents relapse

A

true

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24
Q

a draw back of SSRI/SNRI is that it may take up to ____ to see the full effect

A

6 weeks

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25
true or false SSRI/SNRI can cause withdrawal
true - if abruptly d/c'ed. need to taper down
26
true or false SSRI/SNRI cause sexual dysfunction
true - this is a disadvantage
27
___ and ___ are SSRIs that are FDA approved for GAD which 2 others have been used, but are off label?
paroxetine and escitalopram are FDA approved citalopram and sertraline used off label
28
which 2 SNRI are FDA approved for GAD
venlafaxine and duloxetine
29
if a patient has failed their first RX for anxiety, what is the course of action
try another RX and add cognitive behavioral therapy
30
how long is it recommended to continue anxiety treatment
6-9 months
31
"used for acute symptomalogy in all anxiety disorders"
benzos
32
specific indication for benzos
overlap (bridge) for 2-4 weeks with antidepressants
33
true or false benzos decrease GABA and increase nerve excitability
FALSE increase GABA and decrease nerve excitability
34
true or false pts can get rebound anxiety from d/cing benzos
true
35
BENZO DOSING?
?
36
which benzo is preferred in pts with hepatic dysfunction/older patients
lorazepam
37
name 2 benzos that have parenteral formulations (IM/IV)
lorazepam diazepam
38
benzo that has a fast onset and LONG duration that accumulates along with its metabolite
diazepam
39
benzo that has a LONGGG time to onset and also a long duration
clonazepam
40
benzo that has greater abuse potential and a rapid onset/short duration -- and thus needs frequent dosing
alprazolam
41
pharmacodynamic/pharmacokinetic benzo DDI
dynamic - they are CNS depressants kinetic - CYP3A4 metabolized!
42
3 CYP inducers that decrease conc of benzos
carbamazepine, phenobarbital, phenytoin
43
3 CYP inhibitors that increase conc of benzos
oral contraceptives verapamil protease inhibitors
44
2 concerns of abruptly discontinuing benzos
rebound anxiety seizures
45
the benzo taper is typically patient specific general regimen to taper down if patient was on long term
decrease total dose by 5-10% every 2-4 weeks -shouldn't exceed 25% every 2 weeks (patients who were on lower doses for less than 3 months may tolerate faster taper)
46
true or false buspirone is considered 2nd line for anxiety
true
47
how long does buspirone take to show therapeutic effect
7-10 days
48
true or false buspirone has no abuse potential
true
49
which is preferred for patients with comorbid depression: benzos or buspirone
buspirone
50
option for patients who cant take benzos
buspirone
51
AE of buspirone
dizzy, NAUSEA, headache, nervous, dysphoria
52
true or false antipsychotics are considered 2nd line for GAD
FALSE - lack of evidence for using antipsych for anxiety POTENTIAL options are abilify, quetiapine, risperidone, ziprasidone, olanzapine as adjunct and monotherapy for treatment-refractory GAD, OCD, PSTD
53
what has the strongest evidence of all the atypicals for use for GAD
low dose quetiapine (50-150mg/day)
54
anticonvulsant, anxiolytic, and analgesic that has similar efficacy to lorazepam and venlafaxine for GAD
pregabalin limited use in US but approved in europe
55
what dose of hydroxyzine has anxiolytic properties
50mg/day
56
explain the role of hydroxyzine in anxiety disorders
for acute symptoms PRN bc of sedating effects and also anticholinergic side effects
57
why is Kava Kava not really recommended for anxiety
hepatotoxicty and DDI with p450
58
valerian precautions
GI upset
59
st johns wort + SSRIs
serotonin syndrome
60
true or false lavender oil is generally well tolerated
true - but insufficient evidence it helps with GAD
61
5-hydroxytryptophan is a CAM that can potentially be used for GAD what is a precaution
GI upset and possible eosinophilia-myalgia syndrome
62
propranolol indication
adjunct to SSRI/SNRI for PERFORMANCE ANXIETY for patients who have PHYSICAL symptoms - high HR, sweating, blushing
63
dose of propranolol for performance anxiety
10-80mg 1 hr prior to event
64
note when giving propranolol for performance anxiety
give a test dose before the event to assess tolerability
65
first like for PTSD
SSRI/SNRI only paroxetine and sertraline are actually FDA approved tho
66
**what is CONTRAINDICATED IN PTSD
benzodiazepines
67
TRUE OR FALSE Drugs are always superior to treat PTSD
FALSE trauma-focused psychotherapy may be superior
68
___ can be used for PTSD-related night terrors what to monitor?
prazosin decreases nightmares and sleep disturbances (controversial) monitor BP with dose escalation! alpha 1 blocker
69
2 subtypes of panic disorder
with and without agoraphobia (fear of difficulty escaping or smth)
70
true or false prn benzos are 1st line for panic attacks
false - not recommended
71
recommendations for panic disorder
Cognitive behavioral therapy SSRI/SNRI + a SHORT TERM scheduled benzo sertraline and lexapro in particular had high rates of remission with low risk of AE!
72
length of cognitive behavioral therapy for panic disorder length of SSRI/SNRI/TCA? length of benzo?
CBT - 8-20 SESSIONS SSRI/SNRI/TCA - at least 6 months -- then assess benzo - few weeks then taper off slowly
73
OCD is recurrent obsessions and compulsions of at least ______ and they interfere with some aspect of functioning
1 hour/day
74
obession vs compulsion
both are present in OCD obesssion - intrusive/recurrent thoughts that can't be suppressed. causes anxiety compulsion - repetitive behavior to prevent/reduce stress caused by the obsession
75
4 questions in screening for OCD
- do you have to wash ur hands over and over -do you have to keep checking things -do you have recurrent distressing thoughts you can't get rid of -do you have to complete actions again and again a certain way
76
treatment for OCD
CBT SSRI clomipramine (TCA) 2nd line - venlafaxine/duloxetine can also do augmentation - combine any of these/add an antipsychotic
77
true or false OCD generally takes shorter to respond to medications than depression
FALSE - OCD takes longer. trials have to be at least 12 weeks
78
true or false higher drug dose leads to greater response for OCD patients
true
79

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