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29 Cards in this Set
- Front
- Back
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treatment for mild GAD and moderate-severe GAD
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mild=psychotherapy
mod-sev=psych + pharmacotherapy |
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non-pharmacological therapy for anxiety d/o
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-avoid caffeine, drugs of abuse, stimulants
-CBT -relaxation therapy |
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acute pharmacotherapy
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BZDs
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long-term pharmacotherapy
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-venlafaxine
-paroxetine -escitalopram -buspirone (2nd line) |
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BZD properties and which are tolerance dependent
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-anxiolytic
-sedative (T) -anticonvulsant (T) -muscle relaxant (T) |
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lipophilic BZDs
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chlorazepate, diazepam
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less lipophilic BZDs
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lorazepam, oxazepam
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agents that are recommended for use in elderly patients & patients having hepatic dysfunction
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-temazepam, lorazepam, oxazepam (conjugated only, don't undergo hepatic oxidation)
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BZD C/I (5)
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-alcohol intox
-chronic pulm insufficiency -sig hepatic dz -sleep apnea -comorbid substance use d/o |
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BZD w/drawal sxs
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-anxiety
-insomnia -muscle tension -seizures |
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Buspirone MOA
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5-HT1a partial agonist
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buspirone advantages
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-no abuse potential
-no sedation or impairment of motor activity |
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buspirone d/advantages
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-long onset of effect
-no cross tol w/ BZDs -previous users of BZDs may not think they respond as well |
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buspirone onset of effect
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at least 1 month
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Panic d/o 1st line agents + OOA
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SSRIs, antipanic effect usually seen in 4-6wks, but may take up to 12wks
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1st line agents in patients requiring rapid relief of anticipatory anxiety and patients who are unable to tolerate antidepressants; OOA
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BZDs, antipanic effects usually seen w/in 1 wk
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Other agents for panic d/o
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-selected TCAs (imipramine, clomipramine)
-venlafaxine -MAO-Is |
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SSRI starting dose
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1/4-1/2 recommended starting dose
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alprazolam recommended initial dose and antipanic dose
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-0.25mg-0.5mg tid
-4-10mg daily in DD |
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clonazepam initial dose and antipanic dose
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-0.25mg bid
-3-6mg in DD |
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guidelines suggest treatment should not be d/c in patients having: (3)
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-severe panic d/o
-hx of severe relapse -high levels of current stress |
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OCD 1st line agents
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SSRIs
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OCD 2nd line agent
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clomipramine (selected after 2-3 failed SSRIs)
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post-traumatic stress d/o (PTSD) 1st line agents
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SSRIs
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PTSD 2nd line agents
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venlafaxine, mirtazapine
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these agents may decrease anger and aggression related to PTSD
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mood stabilizers
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these agents may decrease nightmares and improve sleep in PTSD
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antiadrenergics (alpha1 blockers)
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SAD 1st line agents
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SSRIs
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SAD other agents
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-venlafaxine
-BZDs -MAO-Is -propanolol prn 1-2hrs before a presentation or performance |
