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PR3153 > IC 15 - Anxiety and Sleep Disorder > Flashcards

IC 15 - Anxiety and Sleep Disorder Flashcards

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1
Q

What are anxiety disorders characterized by?

A

Severe, excessive, persistent anxiety and irrational fears that impairs functioning

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2
Q

How long does anxiety disorders lasts?

A

> 6 months

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3
Q

What are the 5 anxiety disorders that are amendable to drug treatments?

A
  1. Panic disorder
  2. Social Anxiety
  3. Generalized Anxiety
  4. OCD
  5. PTSD
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4
Q

What regulates the fear and worry circuit?

A

Amygdala (Fear)
Cortico-striatal-thalamic cortical loop (Worry)

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5
Q

What are the three neurotransmitters involved in anxiety disorders?

A
  1. Norepinephrine
  2. Serotonin
  3. GABA
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6
Q

List 4 medical conditions/categories associated with anxiety

A
  1. CVS (e.g. HF)
  2. Endocrine (e.g. hyperthyroidism)
  3. Neurologic (e.g. dementia and delirium)
  4. Pulmonary (asthma, COPD)
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7
Q

What is panic attack?

A

A discrete period of intense fear/ discomfort where someone experience 4 or more panic symptoms abruptly and reach peak within 10 minutes, lasting for up to 30 minutes

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8
Q

What is generalized anxiety disorder?

A

Excessive anxiety and worry occurring more days than not for ≥ 6 months about a number of events or activities.

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9
Q

List the 6 symptoms associated with GAD?

A
  1. Restless/ on the edge
  2. Fatigue
  3. Difficulty concentrating
  4. Irritable
  5. Muscle tension
  6. Sleep disturbance
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10
Q

What is panic disorder?

A
  1. Recurrent unexpected panic attacks
  2. Persistent anticipatory anxiety of another episode
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11
Q

What are social anxiety disorder?

A

Marked and persistent fear of ≥ 1 social/; performance situations and possible scrutiny by others that will be humiliating and embarrassing.

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12
Q

What are the clinical presentations of social anxiety disorders?

A

Avoidance/ endurance with intense anxiety/ distress of feared social/ performance situations that impair function.

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13
Q

What is the clinical presentation of OCD?

A
  1. Obsessions: recurrent and persistent thoughts/ impulses/ images that are intrusive and inappropriate and causes marked anxiety and distress
  2. Compulsions: Repetitive behaviors or mental acts that are unrealistic, excessive and aimed to prevent or reduce distress.
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14
Q

What are the clinical presentation of PTSD?

A
  1. Persistent re-experiencing of intrusion symptoms
  2. Avoidance of trauma-related stimuli
  3. Negatively altered cognitions and mood (e.g. “ I am bad”
  4. Altered arousal and reactivity (e.g. self harm)
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15
Q

How long should symptoms for PTSD persist?

A

> 1 month

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16
Q

What is the main non-pharmacologic therapy that is used for most anxiety disorder?

A

Cognitive Behavioral Therapy

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17
Q

Cognitive Behavioral Therapy is used ______ with medications.

A

in conjunction

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18
Q

What are the possible pharmacotherapy for GAD?

A
  1. SSRIs
  2. Venlafaxine XR
  3. Pregabalin
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19
Q

Which class of medications can be used for panic, social anxiety disorder, and PTSD?

A

SSRIs

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20
Q

What are the medications that can be used for OCD?

A
  1. SSRIs
  2. Clomipramine
  3. Venlafaxine
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21
Q

List three classes of drugs that are useful for long-term management of anxiety disorders, OCD and PTSD.

A
  1. SSRIs
  2. SNRIs
  3. Clomipramine
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22
Q

What is one side effects that patients can experience after starting antidepressant for the first 1 to 2 weeks?

A

Jitteriness

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23
Q

What is the recommended adjunct therapy for anxiety disorders?

A

Benzodiazepines

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24
Q

Serotonergic antidepressants are suitable for symptoms in anxiety associated with _________.

A

excessive worrying

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25
What is the duration of anxiety disorder treatment?
1 to 2 years, typically long-term
26
When will full response of serotonergic antidepressants be achieved for anxiety disorders?
3 months
27
What are benzodiazepines useful for in treatment of anxiety disorders?
Physical symptoms (e.g. muscle tension)
28
How long are benzodiazepines given to treat anxiety disorders?
Short term ( 3 to 4 months) of treatment PRN
29
_____ is required for benzodiazepines to prevent dependence.
Gradual tapering
30
What are the high potency benzodiazepines that can be used in anxiety disorders? List three.
Clonazepam Lorazepam Alprazolam (usually for panic disorder)
31
Name the SSRIs that are FDA approved for GAD.
Escitalopram Paroxetine
32
Name the SNRIs that are FDA approved for GAD.
Venlafaxine XE, duloxetine
33
Which antihistamines can be given as anxiolytic or hypnotic for GAD?
Hydroxyzine
34
List one anticonvulsants that can be used for GAD.
Pregabalin
35
What is the SNRI that is FDA approved and can be used for PD and Social anxiety attack?
Venlafaxine XR
36
What are the SSRIs that are FDA approved and can be used for PD?
Fluoxetine, Paroxetine, Sertraline
37
What are the SSRIs that are FDA approved and can be used for SAD?
Fluvoxamine, Paroxetine, Sertraline
38
What are the SSRIs indicated for OCD?
Fluoxetine, fluoxamine, Paroxetine, Sertraline
39
What are the SSRIs approved by FDA for treatment of PTSD?
Paroxetine, Sertraline
40
What are some general DDI of anti-depressants?
1. Alcohol and CNS depressants 2. Anticholinergics 3. MAOIs and SSRIs/ TCAs combinations - serotonin syndrome
41
What are some DDI that may occur for benzodiazepines?
1. CNS depressants 2. Opioid (increased mortality)
42
What is the hormone that are secreted during sleep?
Melatonin
43
What are the 5 neurotransmitters that promotes alertness?
NE, DA, Ach, Histamine, Orexin
44
What is insomnia disorders?
Inability to initiate or maintain sleep, associated with daytime problems
45
What are the primary complains of unsatisfying sleep quantity or quality ?
1. Difficulty with sleep initiation 2. Difficulty with sleep maintenance 3. Early-morning awakening
46
How long should symptoms for insomnia occur?
At least 3 nights per week and present for at least 3 months
47
Acute sleep insomnia is likely due to ____ .
acute stressor
48
What are the management for acute transient (< 1week) insomnia?
Sleep hygiene
49
What is the management for acute short term (<4weeks) insomia?
Short PRN course of hypnotics for 7 to 10 days
50
What are the causes of chronic insomnia?
Secondary to underlying psychiatric and/or medical problems
51
What are the medications that can be used for treatment of insomnia?
1. Fast acting anxiolytics/ sedatives/ hypnotics (adjuncts)
52
What is the duration of treatment of insomnia?
1 to 2 weeks
53
What is the first line treatment for non-pharmacological treatment for insomnia?
Sleep hygiene
54
List two benzodiazepines that can be used as hypnotics for insomnia.
Lorazepam and Diazepam
55
List two Z-hypnotics that can be used for insomnia.
Zolpidem and Zopiclone
56
What is one side effect of Zopiclone?
Taste disturbance
57
What is one side effects of Z-hypnotics?
Complex sleep behaviors
58
List two antihistamines that may be used for insomnia.
Promethazine, hydroxyzine
59
Which populations are Lemborexant contraindicated in?
Narcolepsy, severe hepatic impairment and moderate-strong CYP3A inhibitors
60
List one group of patients that cannot be given benzodiazepines?
Respiratory depression

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