Exam 4 - Lec 61 Anxiety Ott

Question 1

drugs that can cause anxiety (6)

Answer 1

albuterol
caffeine (high dose)
decongestants
levothyroxine
steroids
stimulants (ADHD meds)

Question 2

buspirone is an agonist of what receptor?

Answer 2

5HT-1A

Question 3

buspirone is approved for use in what disorder?

Answer 3

generalized anxiety disorder (GAD)

(can be first line)

Question 4

buspirone dose for GAD

Answer 4

10-15 mg TID (30-45 mg total/day)

Question 5

how long does it take for buspirone to work? (range)

Answer 5

3-4 weeks

Question 6

which BZDs do not have an active metabolite? (4 of them bolded)

Answer 6

alprazolam
lorazepam
clonazepam
oxazepam

Question 7

which BZDs have a long-acting active metabolite? (3 of them)

Answer 7

diazepam
clorazepate
chlordiazepoxide

Question 8

T or F: d/c of BZDs requires a slow taper over weeks to months

Answer 8

T

Question 9

look at slide 7 for SE of BZDs

Answer 9

ok

Question 10

T or F: according to the Beer’s Criteria, BZDs may be inappropriate in the elderly

Answer 10

T (but there are some we can still use)

Question 11

preferred BZDs in the elderly (3 of them)

Answer 11

lorazepam
oxazepam
temazepam

Question 12

T or F: hydroxyzine pamoate is FDA-approved for GAD

Answer 12

T

Question 13

_________ is most commonly used PRN for anxiety or insomnia instead of a BZD

Answer 13

hydroxyzine

Question 14

SE of hydroxyzine

Answer 14

prominent sedation and anticholinergic effects, QTc prolongation risk

Question 15

T or F: hydroxyzine is preferred in the elderly for GAD

Answer 15

F (avoid in elderly due to anticholinergic SE and fall risk)

Question 16

which of the following is FALSE about propranolol?

a. decreases physiological sx of acute anxiety
b. useful for performance and situational anxiety
c. used in high doses
d. evaluate for asthma and CV conditions

Answer 16

c. used in high doses (low doses)

Question 17

look at slide 10 for natural products

Answer 17

okay

Question 18

T or F: gabapentinoids are NOT considered in pt with bipolar disorder who has anxiety sx or comorbid neuropathic pain

Answer 18

F (can be considered)

Question 19

T or F: sleep medicine does NOT endorse the use of quetiapine for insomnia

Answer 19

T

Question 20

first line drug therapy for all anxiety disorders (two classes)

Answer 20

SSRIs and SNRIs

Question 21

T or F: BZDs are NOT FDA-approved for anxiety

Answer 21

F (FDA-approved, but use only if necessary)

Question 22

T or F: atypical antipsychotics are FDA-approved for anxiety disorders

Answer 22

F (but evidence suggest efficacy for tx-resistant OCD - aripiprazole and risperidone)

Question 23

two atypical antipsychotics for treatment-resistant OCD

Answer 23

aripiprazole and risperidone

Question 24

for GAD to be diagnosed, how long must excessive anxiety be present?

Answer 24

at least 6 months

Question 25

GAD symptoms (there are 6 of them; must meet at least 3; slide 13)

Answer 25

-restlessness/feeling on edge
-easily fatigued
-difficulty concentrating or mind “going blank”
-irritability
-muscle tension
-sleep disturbances

Question 26

when can SNRI antidepressants be used first-line for GAD?

Answer 26

if pt also has a pain syndrome

Question 27

what role do BZDs play in GAD when used with a SSRI/SNRI?

Answer 27

bridge therapy to cover time until onset of SSRI/SNRI (must taper if pt been taking long term)

Question 28

how long for SSRIs to work for GAD? (range)

Answer 28

2-4 weeks

Question 29

how long must symptoms be present to be diagnosed with Social Anxiety Disorder?

Answer 29

at least 6 months

Question 30

which two SSRIs are approved for tx of Social Anxiety Disorder?

Answer 30

paroxetine
sertraline

Question 31

which SNRI is approved for tx of Social Anxiety Disorder and is usually second line if SSRI fails?

Answer 31

venlafaxine

Question 32

which disorder includes an abrupt surge of intense fear or discomfort and must have at least 4 physical and psychological sx, including sweating, palpitations, nausea, dizziness, fear of losing control, “going crazy”, or dying?

a. GAD
b. Social Anxiety Disorder
c. Panic Disorder
d. OCD

Answer 32

c. Panic Disorder

Question 33

Look at slide 17 for more info on Panic Disorder

Answer 33

Ok

Question 34

_____ are first line maintenance tx for Panic disorder

Answer 34

SSRIs

Question 35

step-wise therapy for Panic Disorder

Answer 35

SSRI -> SNRI (venlafaxine) -> BZD (clonazepam/alprazolam)

Question 36

which of the following is TRUE about the tx of OCD?

a. SNRIs are first line
b. 50-75% reduction in sx expected
c. clomipramine is second line
d. antipsychotics are FDA-approved for OCD

Answer 36

c. clomipramine is second line

(a is SSRI; b is 25-50%; d is not approved, but may be considered as augmentation therapy with SSRIs/SNRIs)

Question 37

which antipsychotic has the best clinical data for effectiveness when used as augmentation therapy for OCD?

a. haloperidol
b. risperidone
c. aripiprazole
d. quetiapine
e. olanzapine

Answer 37

b. risperidone

Question 38

4 cardinal symptoms of PTSD

Answer 38

-flashbacks/reexperiencing
-avoidance
-hypervigilance (basically being on high alert)
-negative alterations in mood or cognition

Question 39

which of the following is FALSE about PTSD?

a. SSRIs/SNRIs are first line
b. doxazosin may be helpful for sleep or nightmares
c. BZDs are not recommended
d. polytherapy and substance use is common
e. CBT and eye movement desensitization and reprocessing may be helpful

Answer 39

b. doxazosin may be helpful for sleep or nightmares

(prazosin, not doxazosin)

Question 40

“________” syndrome can result from use of SSRIs and SNRIs when treating anxiety disorders, and initial doses should be lower than those for depression to minimize SE

Answer 40

“jitteriness”

Question 41

T or F: abrupt d/c of BZDs can be life-threatening

Answer 41

T

Question 42

T or F: psychotherapy and CBT are mainstays of tx for anxiety disorders

Answer 42

T

Question 43

in PTSD, drug therapy may be more effective in _______ trauma versus _______ trauma, so non-drug txs are especially useful

Answer 43

civilian; combat

(civilian trauma is usually one-time event; combat trauma has events occurring over longer period of time)