Chapter 66: Anxiety Flashcards
(33 cards)
Which key drugs cause anxiety?
Albuterol (if used too frequently or incorrectly)
Antipsychotics (e.g., aripiprazole, haloperidol)
Bupropion
Caffeine, in high doses
Decongestants
Illicit drugs
Levothyroxine (if therapeutic OD occurs)
Steroids
Stimulants
Theophylline
What are natural products used for anxiety & their warnings/SE
- St. John’s Wort (strong 3A4 inducer, causes photosensitivity & is serotonergic)
- Valerian (some products may be contaminated with liver toxins)
- Passionflower is safe & “possibly effective”
- Kava (severe liver damage, NOT recommended)
Which drug class is recommended first line for anxiety?
SSRIs & SNRIs
How long do SSRIs take at higher doses for a noticeable effect?
4 weeks
List SSRIs and SNRIs used for anxiety
- Escitalopram
- Fluoxetine
- Paroxetine
- Sertraline
- Duloxetine
- Venlafaxine
Which medication is a more favorable add-on medication than BZDs in elderly patients d/t less sedation?
Buspirone
Buspirone will not provide immediate relief of anxiety. It will take at least ____ for effect.
2-4 weeks
Which medication can be used short-term, as needed, as an alternative to BZDs?
Hydroxyzine (Vistaril)
Which medications are not FDA approved for anxiety but have shown benefit in patients with anxiety and neuropathic pain?
Pregabalin (Lyrica) & Gabapentin (Neurontin)
Which medication is not FDA approved for anxiety but can reduce symptoms of stage fright or performance anxiety (e.g., tremor, tachycardia)?
Propranolol (Inderal LA)
MOA of buspirone is unknown, but its effects may be due to its affinity for which receptors?
5-HT1A and 5-HT2
CI for buspirone?
Do not use with MAOi within 14 days
Which medication used for anxiety could you give someone with a history of drug abuse?
Buspirone
What is the mechanism of action (MOA) of benzodiazepines (BZDs)?
BZDs enhance GABA, which is an inhibitory neurotransmitter, causing CNS depression.
Which drug class can be useful for short-term treatment of acute anxiety that is preventing restful sleep?
Benzodiazepines.
For how long should benzodiazepines be used before discontinuation?
1-2 weeks.
What must be done if benzodiazepines are used for longer periods of time?
They must be tapered off slowly to prevent withdrawal symptoms.
Why are BZDs inappropriate for patients older than 65 years?
They have a high risk of confusion, dizziness, and falls in the elderly.
Which benzodiazepines are safer to use in elderly patients and patients with liver impairment?
L-O-T: Lorazepam, Oxazepam, Temazepam.
What are the preferred BZDs for anxiety in everyone besides elderly and patients with liver impairment?
C-L-A-D: Clonazepam, Lorazepam, Alprazolam, Diazepam.
What are the preferred BZDs for sleep?
Lorazepam or Temazepam.
Alprazolam brand name
Xanax
Clonazepam brand name
Klonopin
Diazepam brand name
Valium
