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PT2 Psych 7-12 > anxiety therapeutics > Flashcards

anxiety therapeutics Flashcards

1
Q

drug induced anxiety drugs

A
  • anticonvulsants
  • antidepressants
  • bronchodilators
  • corticosteroids
  • dopamine agonists
  • ecstacy
  • stimulants
  • sympathomimetic
  • levothyroxine
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2
Q

first line drugs for anxiety

A

SSRI

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3
Q

psychological symptoms of anxiety

A
  • worry
  • edginess
  • restlessness
  • irritability
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4
Q

physiologic symptoms of anxiety

A
  • tachycardia
  • shortness of breath
  • digestive problems
  • muscle aches
  • insomnia
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5
Q

diagnosis of GAD

A
  • persistent symptoms most days for at least 6 months

- at least 3 symptoms present

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6
Q

GAD features

A
  • onset is gradual
  • women 2x more likely
  • substantial interference with life
  • depression is common
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7
Q

psychological symptoms of GAD

A
  • excessive anxiety
  • worries are difficult to control
  • feeling on edge
  • poor concentration
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8
Q

physical symptoms of GAD

A
  • restlessness
  • fatigue
  • muscle tension
  • sleep disturbance
  • irritability
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9
Q

beck anxiety inventory

A

21 question self test to evaluate anxiety severity

  • 0-21 low
  • 22-35 moderate
  • 36-63 severe
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10
Q

treatment sequence of GAD

A
  • First line SSRI or SNRI

- second line benzo, buspirone, TCA, pregabalin

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11
Q

nonpharm strategies for GAD

A
  • exercise
  • adequate sleep
  • psychotherapy
  • meditation
  • counseling
  • avoid caffeine/stimulants
  • CBT
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12
Q

SSRIs to use in GAD

A

escitalopram
paroxetine
sertraline

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13
Q

SNRIs to use in GAD

A

duloxetine

venlafaxine XR

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14
Q

benzos to use in GAD

A

alprazolam, clonazepam, diazepam, lorazepam, oxazepam

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15
Q

SSRI/SNRI response time in anxiety

A

2-6 weeks

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16
Q

SSRI/SNRI dosing

A

start low and titrate up

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17
Q

how long to use benzos in anxiety

A

2-6 weeks while overlapping with SSRI/SNRI

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18
Q

benzos in elderly pts

A

more sensitive to sedatives so use lower doses

BEERS list

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19
Q

Buspirone use

A

anxiety only;

great when can’t use benzo

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20
Q

buspirone dosing

A

daily

may take 2-4 weeks to be effective

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21
Q

buspirone side effects

A

GI distress
dizziness
nervousness

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22
Q

buspirone in pregnancy

A

pregnancy category B, so safe

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23
Q

advantages of buspirone

A
  • less sedation
  • no tolerance or dependence
  • no toxicity
  • useful in COPD
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24
Q

disadvantages of buspirone

A
  • can’t use prn
  • may take 2 weeks to take effect
  • can’t use for panic
  • if on benzos start during benzo taper
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25
Q

sedating antihistamines

A

hydroxyzine

diphenhydramine

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26
Q

antihistamine adverse effects

A

anticholinergic

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27
Q

panic attack features

A
  • 4 physiologic and physical symptoms
  • last no more than 20-30 minutes, peak at 10
  • mimic several medical conditions
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28
Q

psychological symptoms of panic disorder

A
  • depersonalization
  • derealization
  • fear of losing control
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29
Q

physical symtpoms of panic disorder

A
  • abdominal distress
  • chest pain
  • chills
  • dizziness
  • feeling of choking
  • hot flashes
  • palpitations
  • nasuea
  • paresthesias
  • SOB
  • sweating
  • tachycardia
  • shaking
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30
Q

agoraphobia

A

anxiety about being in places or situations in which escape might be difficult

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31
Q

treatment sequence of panic disorder

A
  • 1st line SSRI/SNRI

- 2nd line TCAs, benzo

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32
Q

most commonly used drugs in panic disorder

A

benzos

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33
Q

benzo dosing in panic disorder

A

schedule doses multiple times per day at low doses

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34
Q

benzos commonly used in panic disorder

A

alprazolam
clonazepam
lorazepam

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35
Q

treatment strategy for panic attacks

A

start SSRI/SNRI and bridge with schedule benzo; stop benzo after 2-4 weeks

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36
Q

difference between SAD and PD

A

both can have panic attacks, the difference being the rationale (fear of anxiety vs embarrassment)

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37
Q

treatment for social anxiety

A
  • 1st line SSRI/SNRI

- 2nd line gabapentin, BZD

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38
Q

propranolol use in anxiety

A

can be used for performance anxiety

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39
Q

propranolol dosing

A

10-80 mg with a test dose at home to see how BP is affected

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40
Q

treatments for specific phobia

A
  • CBT
  • benzos can be detrimental
  • drug therapy is not effective
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41
Q

obsessive compulsive disorder diagnosis

A

presence of obsessions and/or compulsions that are severe enough to:

  • cause marked distress
  • be time consuming
  • cause social or occupational impairment
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42
Q

obsessions

A

involve themes of harm or danger

  • repetitive thoughts
  • repetitive images
  • repetitive impulses
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43
Q

treatment options for OCD

A
  • exposure therapy
  • psychotherapy to help change beliefs
  • SSRI
  • clomipramine
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44
Q

SSRI in OCD

A

often used first line and at a high dose

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45
Q

avoid clomipramine for OCD in who

A

elderly due to sedating/anticholinergic effects

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46
Q

time to SSRI and clomipramine response in OCD

A

8-12 weeks

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47
Q

benzo use in OCD

A

not useful

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48
Q

PTSD features

A
  • exposure to actual or threatened death
  • reexperiencing/avoiding the event
  • lasts for over 1 month
  • causes significant distress/impairment
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49
Q

treatment for PTSD

A
  • psychotherapy
  • SSRI & venlafaxine
  • maybe TCA or MAOI
50
Q

SSRIs to use in PTSD

A

sertraline (long term and acute)

paroxetine (acute)

51
Q

when to start SSRI in PTSD

A

try to start within 3-4 weeks of the trauma

52
Q

prazosin in PTSD

A

augment therapy used to treatment nightmares

53
Q

prazosin MoA

A

alpha-1 adrenergic antagonist

54
Q

prazosin side effects

A

orthostatic hypotension

55
Q

how long to treat PTSD with an SSRI

A

at least 1 year

56
Q

neurotransmitters that promote sleep

A

GABA
melatonin
adenosine

57
Q

neurotransmitters that promote wakefulness

A 
NE
DA
serotonin
histamine 
ACh
Orexin
58
Q

drugs that agonize GABA

A
  • Z drugs
  • alcohol
  • benzos
59
Q

drug that agonizes melatonin

A

ramelteon

60
Q

drug that antagonizes adenosine

A

caffeine

61
Q

drugs that agonize NE and DA

A

stimulants

62
Q

drugs that antagonize serotonin

A

trazodone

mirtazapine

63
Q

drugs that antagonize histamine

A

antihistamines

mirtazapine

64
Q

drugs that antagonize acetylcholine

A

antihistamines

TCAs

65
Q

drug that antagonizes orexin

A

suvorexant

66
Q

normal sleep latency time

A

15-30 minutes

67
Q

normal sleep efficiency (sleep time spent sleeping)

A

85%

68
Q

dyssomnias

A
  • insomnia
  • hypersomnia
  • narcolepsy
  • sleep apnea
  • circadian rhythm sleep-wake disorder (jet lag)
69
Q

parasomnias

A
  • nightmare

- sleep walking

70
Q

secondary or comorbid sleep disorders

A
  • stress
  • depression
  • bipolar
  • CNS stims/depressants
  • hyperthyroid and other medical conditions
71
Q

highest risk patients for insomnia

A
  • middle aged to older adults
  • women>men
  • unemployed, divorced or widowed, low SES
  • comorbid conditions
72
Q

transient insomnia

A

occurs for 1-3 days

73
Q

acute/short term insomnia

A

less than 4 weeks

74
Q

chronic insomnia

A

lasts over a month

75
Q

symptoms of insomnia

A
  • difficulty falling asleep
  • difficulty maintaining sleep
  • waking too early
  • non-restorative sleep
76
Q

DSM-V diagnosis of insomnia

A
  • at least one of difficulty initiating, maintaining, or early awakening
  • impaired function
  • at least 3 nights per week
  • at least 3 months
  • occurs despite adequate opportunity for sleep
  • not due to mental disorder
77
Q

nonpharm treatment for insomnia

A
  • sleep hygiene training
  • relaxation training
  • CBT
78
Q

expectations of the treatment of insomnia

A
  • many don’t need meds
  • drugs don’t immediately fix sleep
  • immediately falling asleep is not normal
79
Q

sleep hygiene techniques

A
  • regular bed time and wake up time
  • avoid naps
  • sleep only as much as you need
  • go to bed only when sleepy, don’t force
  • use bed for sleep and sex
  • exercise
  • comfortable temp, dark room
  • no alcohol, caffeine, large meals before bed
80
Q

sleep meds are recommended to be used for how long

A

generally less than a month due to risk of dependence and tolerance

81
Q

sedative

A

agents that reduce anxiety

82
Q

hypnotic

A

agent that produces drowsiness and sleep

83
Q

OTC meds for insomnia

A

alcohol
antihistamines
valerian
melatonin

84
Q

diphenhydramine and doxylamine dosing

A

25-50 mg

85
Q

ramelteon MoA

A

melatonin receptor agonist

*no change in sleep architecture

86
Q

ramelteon side effects

A

dizziness
somnolence
fatigue
decreased libido

87
Q

ramelteon dosing

A

8 mg 30 mins before bedtime

88
Q

ramelteon efficacy

A

reduced latency by 9 mins and total sleep time by 10-15 mins (not that great)

89
Q

benzo changes in sleep architecture

A
  • decreased sleep latency
  • increased NREM sleep
  • decreased REM
  • decreased NREM slow-wave
90
Q

temazepam features

A
  • slow onset
  • short duration of action
  • no metabolites
  • less next-day sedation
91
Q

temazepam in pregnancy

A

avoid it, category X

92
Q

benzo contraindications

A

pregnancy
sleep apnea
substance abuse

93
Q

z-drug side effects

A
  • daytime sedation (less than benzos)
  • psychomotor incoordination
  • cognitive deficits
94
Q

antidepressants that can be used for insomnia

A

trazodone
TCAs
mirtazipine

95
Q

trazodone MoA

A
  • inhibits 5HT reuptake

- blocks H1 and alpha-1

96
Q

trazodone adverse effects

A 
dizziness
edema
confusion
GI effects
orthostasis
priapism
97
Q

trazodone place in therapy

A
  • possibly first line, has less AEs

- may be useful in SSRI or bupropion induced insomnia

98
Q

TCAs MoA

A

inhibit reuptake of 5HT and NE

99
Q

side effects of TCAs

A

-low doses have antihistamine effects (anticholinergic, orthostasis, sedation)

100
Q

TCA drugs to use in insomnia

A

doxepine

amitriptyline

101
Q

avoid TCAs in who

A

elderly

102
Q

mirtazipine MoA

A

tetracyclic antidepressant

alpha2-antagonist, 5HT antagonist

103
Q

mirtazipine adverse effects

A

somnolence
weight gain
increased appetite

104
Q

mirtazipine dosing

A

15-45 mg

lower dose = higher sedation

105
Q

when to use mirtazipine

A

only if underlying depression

106
Q

suvorexant MoA

A

orexin receptor antagonist

107
Q

suvorexant adverse effects

A
  • daytime somnolence
  • worsening of depression or suicidal ideation
  • cataplexy
108
Q

suvorexant dosing

A

5-20 mg no more than 30 mins before bed and must have 7 hours to sleep

109
Q

drugs with most reduced sleep latency

A
  1. z-drugs
  2. suvorexant/benzo
  3. ramelteon, melatonin
110
Q

drugs with most increased sleep time

A
  1. antidepressants
  2. benzos
  3. suvorexant
111
Q

insomnia drugs amount of AE rankings

A

benzo > z-drugs > antidepressants

112
Q

narcolepsy 4 main symptoms

A
  • sleep attacks
  • cataplexy
  • hypnagogic hallucinations
  • sleep paralysis
113
Q

nonpharm for narcolepsy

A
  • sleep hygeine

- schedule day time naps

114
Q

drugs for narcolepsy excessive daytime sleepiness

A
  • modafinil
  • armodafinil
  • stimulants
115
Q

drugs for cataplexy, paralysis, and hypnagogic hallucinations in narcolepsy

A

sodium oxybate (only FDA approved)
venlafaxine
fluoxetine
TCAs

116
Q

shift work sleep disorder nonpharm

A
  • naps and exposure to light at night

- exposure to darkness during day

117
Q

shift work sleep disorder drugs

A

modafinil for day time sleepiness

118
Q

treatment for jet lag

A
  • 1-2 hours adjustment in sleep before travel

- melatonin

119
Q

tasimelteon use

A

chronic circadian rhythm disorder in the totally blind

120
Q

tasimelteon MoA

A

melatonin receptor agonist

121
Q

treatment for obstructive sleep apnea

A
  • no drugs
  • weight loss
  • CPAP
  • surgery

PT2 Psych 7-12 (5 decks)

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