Anxiety OCD PTSD therapeutics Flashcards Preview

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Flashcards in Anxiety OCD PTSD therapeutics Deck (17)
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1
Q

GAD

PT and non-PT

A

SSRIs *
Venlafaxine XR *
TCAs
Others: e.g. beta-blockers, hydroxyzine, buspirone

Cognitive behavioral therapy (CBT)*
Psychotherapy
Relaxation
Anxiety Management

2
Q

Panic Disorder

PT and non PT

A

SSRIs *
TCAs

CBT*

3
Q

Social Anxiety Disorder

PT and non PT

A

SSRIs *
MAOIs/RIMAs
MAOIs + Benzodiazepines

Behavioural Therapy

4
Q

OCD

PT and Non PT

A

SSRIs *
Clomipramine *

CBT *
Exposure & Response Prevention (ERP)

5
Q

PTSD

PT and non PT

A

SSRIs *
TCAs

CBT (important 1st line tx)*
Psychotherapy Counselling

6
Q

Cognitive Behavioural Therapy (CBT): used in combination with medications

A

Cognitive Behavioural Therapy (CBT): used in combination with medications

7
Q

All Serotonergic Antidepressants can be useful for long-term management of Anxiety Disorders, OCD, PTSD

eg __________

A

– SSRIs, SNRIs (1st line)

– Clomipramine (3rd line)

8
Q

Approach to Dosing (antidepressant in anxiety)

A

– Starting Dose must be LOW: (“start low go slow”)
• Transient jitteriness in the initial 1-2 weeks of starting antidepressant.
• Start antidepressant at with low dose; consider Benzodiazepine as adjunct

– Maintenance Dose are usually HIGH:
• Effective maintenance dosing of antidepressants for treatment of Anxiety Disorders are on the high end of the dose range (e.g. Fluoxetine 60-80mg/day)

– Discontinuation (SSRI SNRI):
• Gradual taper recommended to avoid discontinuation symptoms
• E.g. ↓dose by 10-25% every 1-2 weeks

9
Q

Serotonergic Antidepressant: – Effective for________

Onset
Full response generally ____
Duration of treatment

A

– Effective for “excessive worrying” type of symptoms in anxiety
• Onset at least 1-2 months
• Full response generally 3 months
– Duration of treatment at least 1-2 years, typically long-term.

10
Q

Adjunctive

A

Benzodiazepines

11
Q

BZD

Effective for
Onset 
Aim for \_\_\_\_\_\_\_ tx 
PD properties
Tolerance 
Dependence 

High potency agents usually preferred in _____
example

Caution

A

Therapeutic action:
– Effective for physical symptoms of anxiety (e.g. muscle tension)
» Fast Onset of Action: can be within 30min (e.g. Lorazepam)
– Aim for short term (3-4 months) of treatment, PRN dosing, then taper.
– PD properties same:
» Anxiolytic, Hypnotic, Muscle relaxation, Anticonvulsant, Amnesic properties

Tolerance
– Tolerance to hypnotic actions common, develops within days.
– Tolerance to anxiolytic action is uncommon

Dependence
– Avoid abrupt cessation after weeks of continued use (withdrawal)
– Gradual taper required (DECREASE in steps of Diazepam 2mg, q2-3 wks)

High potency agents usually preferred in Anxiety disorders
– Alprazolam XR, Clonazepam, Lorazepam

Cautions
– Paradoxical excitement Esp. in children and elderly
– Dependence and withdrawal symptoms can occur especially in patients with history of drug dependence.

12
Q

NOT recommended:

Kava (risks of hepatotoxicity),
Chamomile (avoid in pregnancy),
Valerian (INCREASE GABA)

A

NOT recommended:

Kava (risks of hepatotoxicity),
Chamomile (avoid in pregnancy),
Valerian (INCREASE GABA)

13
Q

2nd line

A

PREGABALIN

14
Q

Alcohol and other CNS depressants increases CNS depressant side effects of benzodiazepines and antidepressants

A

Alcohol and other CNS depressants increases CNS depressant side effects of benzodiazepines and antidepressants

15
Q

MAOIs and SSRIs/TCAs combinations: =====???

A

• Serotonin syndrome:

– restlessness, diaphoresis, tremor, shivering, myoclonus, confusion, convulsions, death.

16
Q

Benzodiazepines_______________ microsomal enzymes but most of them (except possibly ________) are metabolized by the ______________

A

Benzodiazepines do not induce microsomal enzymes but most of them (except possibly Lorazepam) are metabolized by the hepatic cytochrome P450 3A4 (CYP3A4) isozyme

17
Q

Inhibitors of CYP3A4
Inducers of CYP 3A4
and effects on BZD

A

Inhibitors of CYP3A4
– e.g. Fluvoxamine, Fluoxetine, Cimetidine
– may INCREASE benzodiazepine levels

Inducers of CYP 3A4
– e.g. Carbamazepine, Phenobarbitone, Rifampicin
– may DECREASE benzodiazepine levels.