Anxiety Disorders

Front 1

1 Year prevalence rate for Anxiety disorders

Back 1

17%

Front 2

Lifetime prevalence rate for Anxiety disorders

Back 2

25%

Front 3

What is the typical onset for Anxiety disorders?

Back 3

Before age 30

Front 4

Anxiety disorders are more common in which sex?

Back 4

Women

Front 5

Cardiovascular conditions associated with Anxiety disorders

Back 5

Angina, CHF, MI, arrythmias

Front 6

Endocrine/Metabolic disorders associated with Anxiety

Back 6

Hyper/Hypothyroidism, hypoglycemia, cushing's disease

Front 7

Neurologic disorders associated with anxiety

Back 7

CNS tumors, Dementia, migraines, pain, parkinsons, seizures, stroke

Front 8

Respiratory disorders associated with anxiety

Back 8

Asthma, COPD, pulmonary embolus, infections

Front 9

Other disorders associated with anxiety

Back 9

Anemia, lupus

Front 10

Drugs associated with anxiety

Back 10

CNS stimulants, Antidepressants, Antipsychotics, steroids, CNS depressant withdrawal

Front 11

Describe DSM Diagnostic Criteria for Generalized Anxiety Disorder (GAD)

Back 11

1. Excessive anxiety and worry, ocurring more days than not for at least 6 months.
2.Person cannot control worry
3.Anxiety and worry associated with 3 or more of the following (Restlessness, feeling keyed up or on edge, being easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance).
4.Anxiety and worry not caused by some other illness
5.Cosntant worry causing disruption of life
6.Not caused by drug or medical condition

Front 12

Tx for Mild GAD

Back 12

Psychotherapy

Front 13

Tx for Moderate-Severe GAD

Back 13

Psychotherapy + Pharmacotherapy

Front 14

Describe Non-pharm Tx for GAD

Back 14

Avoid caffeine, DOA and stimulants.
Psychotherapy (Cognitive behavioral therapy)
Change maladaptive behaviors by substituting coping mechanisms
Applied relaxation therapy (focuses on excessive worry and muscle tension)

Front 15

Pharmacotherapy overview for Acute GAD

Back 15

BZDs

Front 16

Pharmacotherapy overview for long term GAD

Back 16

Buspirone
Venlafaxine
Paroxetine
Escitalopram

Front 17

Other options Tx wise for Long-term GAD

Back 17

TCA's 3rd line
MAOIs - 3rd or 4th line

Front 18

What is the role of TCA's in treatment of long-term GAD?

Back 18

3rd line alternative

Front 19

What is the role of MAOIs in the treatment of long term GAD?

Back 19

3rd or 4th line alternative

Front 20

What therapeutic properties do BZDs possess?

Back 20

Anxiolytic
Sedative
Anticonvulsant
Muscle Relaxant

Front 21

Advantages to BZD use in GAD

Back 21

Ease of use
Low toxicity
Rapid onset

Front 22

Disadvantages of BZD use in GAD

Back 22

ADR
Potential for tolerance and or dependence (Actually pretty low)

Front 23

What is the primary determinant of a BZDs onset and duration?

Back 23

Lipophilicity

Front 24

__________ and ________ are the most lipophilic and therefore have the most rapid anxiolytic effect but a shorter duration.

Back 24

Clorazepate and diazepam

Front 25

Agents that have a ____________ lipophilicity tend to have the fastest onset and shorter duration.

Back 25

Higher

Front 26

____________ and ___________ are less lipophilic BZDs therefore have a slower onset and a longer duration.

Back 26

Lorazepam and oxazepam

Front 27

Parenteral administration should be avoided with which BZDs?

Back 27

Diazepam and Chloridazepoxide

Front 28

Which BZD is metabolized in the gastric juice to an active metabolite that is completely absorbed?

Back 28

Clorazepate

Front 29

LOT

Back 29

Lorazepam, oxazepam and Temazepam

Front 30

Which BZDs undergo conjugation only and therefore can be used in elderly patients and those with hepatic dyfunction

Back 30

LOT
Lorazepam, Oxazepam and Temazepam

Front 31

Clonazepam undergoes which type of metabolism?

Back 31

Nitroreduction

Front 32

Common BZD ADR's

Back 32

Sedation, drowsiness, ataxia, lethargy, mental confusion, motor and cognitive impairment, disorientation, slurred speech, amnesia.

Front 33

Rare BZD ADR's

Back 33

Paradoxical agitation (Triazolam), depressed respiration

Front 34

BZD Contraindications (6)

Back 34

1.Alcohol
2.Chronic pulmonary insufficiency (Relative)
3.Significant hepatic disease (USE LOT)
4.Sleep apnea (Relative)
5.Comorbid substance use disorders

Front 35

Which BZDs are most commonly abused?

Back 35

Alprazolam and Diazepam

Front 36

How long does it take for individuals to become dependent typically to a BZD?

Back 36

3 weeks or longer of scheduled use

Front 37

BZD Withdrawal symptoms

Back 37

Anxiety, insomnia, muscle tension, seizures

Front 38

Tolerance develops to which effects of BZDS

Back 38

Sedative/Hypnotic
Muscle relaxant
Anti-convulsant
NOT ANXIOLYTIC though

Front 39

If you are attempting to D/C a BZD in a patient who has been taking a short-acting agent, what strategie may help with the tapering?

Back 39

Switch to a long acting agent

Front 40

In the treatment of GAD, Buspirone typically is considered what line of treatment?

Back 40

Second

Front 41

Describe effects and characteristics of Buspirone

Back 41

Non-BZD anxiolytic without sedative-hypnotic, muscle relaxant and anticonvulsant properties

Front 42

Advantages of Buspirone

Back 42

No abuse
No sedation or impairment of motor activity

Front 43

Disadvantages of Buspirone

Back 43

Long onset of effect!!!!
No cross tolerance with BZDs
Previous users of BZDs will not feel they respond as well

Front 44

Buspirone MOA

Back 44

5-HT1a partial agonist

Front 45

Onset of effect for Buspirone

Back 45

Long- a month

Front 46

ADR of Buspirone

Back 46

Dizziness, Nausea, Headaches

Front 47

Drug interactions for Buspirone

Back 47

3A4 inhibitors: Verapamil, diltiazem, itraconazole, erythomycin increase levels
Rifampin - Decrease levels
Serotonergic meds - Serotonin syndrome

Front 48

Describe Panic Disorder

Back 48

Begins as a series of panic attacks, then concern about having another, then they seek medical help due to fear of other medical problems. Patients often develop agoraphobia secondary to panic attacks

Front 49

What is agoraphobia?

Back 49

Fear of being in an inescapable situation

Front 50

NonPharm for Panic Disorder

Back 50

Psychotherapy-CBT
Avoid caffeine, DOA and stimulants

Front 51

1st line Tx for Panic Disorder

Back 51

SSRIs

Front 52

What is the dosing concept for SSRI's in the treatment of panic disorder?

Back 52

Go 1/4 to 1/2 normal starting dose to prevent ADR of anxiety from becoming an issue.

Front 53

BZDs: Role in therapy for panic disorder

Back 53

Used 1st line in patients requiring rapid relief of anticipatory anxiety and patients who cannot tolerate antidepressants.

Front 54

Commonly used BZDs for Panic disorder

Back 54

Alprazolam 0.25-0.5mg TID
Panic dose: 4-10mg daily in divided doses
OR
Clonazepam 0.25mg BID
Panic: 3-6mg in divided dose

Front 55

What other agents may be used in the treatment of Panic disorder

Back 55

Venlafaxine, TCAs, MAOis

Front 56

Which TCAs MAY be used in the treatment of panic disorder?

Back 56

Imipramine and Clomipramine

Front 57

Recommended Tx for Mild OCD

Back 57

Nonpharmacologic therapy only
Psychotherapy (Exposure therapy or response prevention)

Front 58

Recommended Tx for Moderate to severe symptoms

Back 58

Pharmacologic

Front 59

1st line OCD agents

Back 59

SSRIs

Front 60

2nd line OCD agents

Back 60

Clomipramine (After 2-3 failed SSRIs)

Front 61

What are some non 1st or 2nd line agents that may be used for OCD

Back 61

Odansetron or Venlafaxine

Front 62

OCD Augmentation strategies

Back 62

Risperdal
Olanzapine
Seroquel

Front 63

Nonpharmacologic therapy for PTSD

Back 63

Psycho: Anxiety management, CBT, Exposure therapy

Front 64

Pharmacotherapy for PTSD

Back 64

1st line: SSRIs
2nd line: Venlafaxine, mirtazapine

Front 65

1st line agents for SAD

Back 65

SSRIs (4-8 week onset)