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30 Cards in this Set
- Front
- Back
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what type of anxiety disorders are the hardest to achieve remission in
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general anxiety disorder
panic disorder post traumatic stress disorder |
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what anxiety disorder is this
anxiety and worry for 6 months plus 3 of the following restlessness, fatigue, on edge, poor concentration/mind goes blank, irritability, sleep disturbances, muscle tension |
general anxiety disorder
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what is the diagnosis of GAD
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anxiety and worry for atleast 6 months and 3 of the following:
restlessness, fatigue, poor [], mind goes blank, on edge, irritability, sleep disturbances, muscle tension |
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why must you avoid stimulants (caffeine, diet pills, alcohol) in pts with anxiety
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it may provoke anxiety
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what are the 1st line drugs to treat General Anxiety Disorder
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Escitalopram - best choice
Paroxetine - anti-CoA SE at high doses Duloxitine Venlafaxine |
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what is the diagnosis of Panic Disorder
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spontaneous panic attack with fear of having another w/in 1 month
plus fear of self doom during attacks, fear of losing control or dying and 4 physical symptoms (palpitations, sweating, SOB, nausea) |
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what are the 1st line drugs for Panic Disorder
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all SSRI
venlafaxine |
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what is the difference between SAD and PD
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SAD - fear of being embarassed through social interactions
PD - fear of having another panic attack within 1 month |
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what is the diagnosis of Social anxiety disorder
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fear of social performance situations (fear that they may act in a way that is humiliating or embarassing)
<18 years with symptoms present for 6 months |
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what are symptoms of social anxiety disorder
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blushing is principle symptom
diarrhea fear of public speaking or eating in front of others being embarassed/humiliated |
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what are the 1st line agents for Social anxiety disorder
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SSRI (fluvaxamine, sertraline, escitalopram, paroxetine)
SNRI (venlafaxine) |
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how are antidepressants dosed in SAD and PD
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SAD use same dose as used to treat depression
PD use 1/4 dose used to treat depression |
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what is the diagnosis of post traumatic stress disorder
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exposure to traumatic event (event that involved threat of death or injury to pt or pt responded with intense fear, helplessness, horror)
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what are the 3 types of symptoms that a pt with PTSD could have
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reexperiencing symptoms - memories, dreams of event, fear of event recurringt
hyperarousal symptoms - decreased concentration, easily startled, insomnia, angry outbursts avoidance symptoms - can't recall aspects of events, avoid convos about event, don't want to think about event |
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what are the 1st line drugs for PTSD
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sertraline
Paroxetine |
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what anxiety disorder are BZD not effective in
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PTSD
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what is the diagnosis of OCD
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obsessions: repetitive thoughts, images, impulses
compulsions: repetitive activites (hand washing) or repetitive mental acts (repeating words silently) |
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what is used to tx mild and severe OCD
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mild OCD (CBT only)
severe OCD (CBT + SSRI) |
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what are the 1st line drugs to treat OCD
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fluoxetine
fluvoxamine paroxetine sertraline clomipramine after failure of 2-3 SSRI |
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when would clomipramine be used to treat OCD
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after failure with 2-3 SSRI
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what is the most potent BZD
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clonazepam
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what is the MOA of BZD
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bind to GABA-a Rc
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what are the PK of Clorazeptate, Diazepam, Lorazepam, Temazepam, Oxazepam
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Clorazeptate, Diazepam - highly lipophilic and can cross BBB, undergo OXIDATION, reach peak plasma lvl rapidly, long t1/2
Lorazepam, Temazepam, Oxazepam - not very lipophilic therefore harder time crossing BBB, undergo CONJUGATION |
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what is used to treat BZD OD
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flumazenil
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can BZD be use during pregnancy
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no don't use if pt pregnant (teratogenic don't use in 1st trimester)
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what should be done to minimize withdrawal symptoms with BZD
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25% decrease in dose until achieve 50% of dose
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what is used to treat acute anxiety
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BZD
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what is the MOA of Buspirone
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5HT1a partial agonist
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what is the benefits of Buspirone
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no dependence properties
minimal sedative effects non BZD good for substance abuse |
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what is the treatment algorithm for SAD
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SSRI or Venlafaxine
partial response: augment with buspirone or clonazepam response: continue tx for 12 weeks |
