Pharm -- Gad

Front 1

First-line drug classes for GAD

Back 1

SSRIs -- Paroxetine and Escitalopram

Front 2

MOA of Paroxetine

Back 2

Selective Serotonin Reuptake Inhibitor
- Increased 5HT --> less NE --> less glutamate action = calming effect

Front 3

SE profile for Paroxetine

Back 3

- More weight gain and sexual dysfunction than other SSRIs
- General SSRI SE: nausea, dry mouth, dizziness, wt gain, sexual dysfunction

Front 4

SE profile for escitalopram

Back 4

- "Purest SSRI" so less SE
- General SSRI SE: nausea, dry mouth, dizziness, wt gain, sexual dysfunction

Front 5

MOA of Venlafaxine

Back 5

Serotonin-Norepi Reuptake Inhibitor (SNRI)

Front 6

SE of Venlafaxine

Back 6

Nausea, dry mouth, slight weight gain

Front 7

Second-line drug classes for GAD

Back 7

Atypical -- Buspirone
TCAs -- Imipramine
BZDs

Front 8

MOA of Buspirone

Back 8

Partial 5HTa agonist on presynpatic receptors

Front 9

SE of Buspirone

Back 9

Dizziness, nausea, headache
-- Less sexual dysfunction
-- No sedation
(It's actually a very activating agent)

Front 10

For what type of anxiety disorder is Buspirone + SSRI indicated?

Back 10

Obsessive Compulsive Disorder

Front 11

MOA of BZDs

Back 11

Potentiate GABA by enhancing binding to GABA receptors

Front 12

BZD with fastest onset

Back 12

Diazepam

Front 13

BZD with slowest onset

Back 13

Oxazepam

Front 14

BZDs that only under part 2 of metabolism (glucuronide conjugation)

Back 14

LOT: Lorazepam, Oxazepam, Temazepam

Front 15

What conditions necessitate the use of the BZDs that only undergo phase 2 of metabolism (glucuronide conjugation)

Back 15

Less ability of liver to undergo phase 1 metabolism effeciently. This occurs in:
- The elderly
- Hepatic disease
- Polypharmacy

If a BZD undergoes both 1 and 2 phases of metabolism, then the active metabolites build up in the elderly and those w/hepatic dz, causing further problems.

Front 16

SE of BZDs

Back 16

Sedation, confusion, headache, ataxia, difficulty concentration, anterograde amnesia (will resolve after stopping drug)

Front 17

TCA indicated for use in GAD

Back 17

Imipramine

Front 18

SE of TCAs

Back 18

Lots!
- Anticholinergic SE (Anti-SLUD)
- Sedation
- Weight gain, sexual dysfunction

Front 19

Alternative GAD Therapy (Not first or second line)

Back 19

Hydroxyzine

Front 20

MOA of Hydroxyzine

Back 20

Antihistamine

Front 21

SE of Hydroxyzine

Back 21

Sedation, anticholinergic properties (SLUD)

Front 22

Hydroxyzine contraindicated in what type of patient?

Back 22

Elderly