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33 Cards in this Set

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What are the major classes of drugs used to treat anxiety disorders?
1. TCAs
2. SSRIs
3. MAOIs
4. Serotonin-Norepinephrine Reuptake Inhibitors
5. Norepinephrine-Dopamine Reuptake Inhibitors
6. 5-HT2 antagonists
7. alpha2 antagonists
What TCAs are used to treat anxiety disorders? (2)
1. imipramine – 1st agent to be shown to be efficacious in panic disorder
2. clomipramine
Advantages of TCAs:
• Lower cost
• Efficacious in non-SSRI responders
• Once daily dosing
Disadvantages of TCAs:
• Side effects
• Initally heightened anxiety
• Cardiotoxicity due to overdose
• Higher overall cost (blood levels)
• Delayed onset of action
How should TCAs be initiated?
Start at low doses, use typical antidepressants, and check levels after 5 days
What are the MAOIs used for anxiety?
Phenelzine
Tranylcypromine
What are the advantages of using MAOIs?
Efficacious in treatment-resistant patients
Disadvantages of using MAOIs?
•Side effects
•Orthostatic hypotension
•Weight gain
•Sexual dysfxn
•Dietary restrictions
•Toxicity in overdose
What SSRIs are used for anxiety?
•Fluoxetine
•Paroxetine
•Sertraline
•Fluvoxamine
•Citalopram
•Escitalopram
What class of drugs are considered “1st line” treatment for anxiety? What do they do?
SSRIs

they dysregulate the central serotonergic system
What 2 drugs are FDA-approved for treatment of panic disorder?
Paroxetine and sertraline
What are the advantages of using SSRIs for anxiety?
•Favorable S/E profile
•Broad spectrum efficacy
•Low abuse potential
•Safe in overdose
•Once daily dosing
What are the disadvantages of using SSRIs for anxiety?
•Restlessness
•“jitteriness”
•increase anxiety on initial dosing (so start at lower doses)
•delayed onset of action
What other classes of Antidepressants can be used for anxiety?
•SNRI
•NDA
•5HT2 antagonist
•alpha-2 antagonist
What drug for anxiety is an SNRI?
Venlafaxine (Effexor) – good for pain disorders
What drug for anxiety is an NDA?
Buproprion (Wellbutrin, Zyban) – initially increases anxiety
What drug for anxiety is a 5-HT2 antagonist?
Nefazodone (Serzone) – can cause liver failure
What drug for anxiety is an alpha-2 antagonist?
Mirtazapine – causes sedation and weight gain
What is the MOA for Benzos? How effective are they for anxiety compared to TCAs?
GABA receptor agonists; as potent as TCAs
What are the advantages of using Benzos for anxiety?
•Highly efficacious
•Rapidly acting
•Favorable S/E profile
What are the disadvantages of using Benzos for anxiety?
•Potential for abuse
•Withdrawl symptoms
•Initial sedation and ataxia
•Increased sedation in the elderly
•Interactions w/ alcohol
•Short-term memory impairment
What other (non-antidepressant) meds can be used for anxiety?
1. Partial 5-HT-1A agonist: Buspirone – not effective for panic disorder, but used for anti-anxiety properties
2. Beta-blockers – reduce somatic symptoms of autonomic arousal; useful for performance anxiety
3. Anticonvulsants
4. Atypical antipsychotics
What drug for anxiety is a 5-HT-1A agonist?
Buspirone
What drugs are 1st line for panic disorder?
Paroxetine and sertraline
What drugs are 1st line for GAD?
Buspirone +/- benzos
What drugs are 1st line for PTSD?
Paroxetine and sertraline
What drugs are 1st line for OCD?
Fluvoxamine, fluoxetine, paroxetine, sertraline
What drugs are 1st line for social phobia?
Paroxetine and sertraline
What drugs are 1st line for performance anxiety?
Beta-blocker, benzos
How common are anxiety symptoms in the elderly?
10-20%
What S/Es may be seeing in the treatment of anxiety in elderly patients:
• Sedation
•Confusion or delirium
•Memory problems
•Gait imbalances/dizziness
•Sleep disturbances
What role do metabolic changes play in treating women for anxiety?
Water retention and fluid shifts may require larger medication doses
What class of drugs causes sexual dysfunction?
SSRIs (<10% of patients)

usually impotence or delayed orgasm