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47 Cards in this Set
- Front
- Back
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Overactivity of what leads to a state of constant arousal and hypervigilance?
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norepinephrine
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What are some substances and/or medical conditions that can cause severe anxiety or panic?
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caffeine, alcohol, nicotine, cold meds, cannabis, amphetamines, cocaine, hyperthyroidism, hyperparathyroidism, pheochromocytoma, seizure d/o, cardiac arrhythmias, copd, hypoglycemia, angina, parkinson's, depression, schizophrenia, bipolar d/o, eating d/o, life changes
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What are the four pharmacologic effects obtained from benzodiazepines?
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anxiolytic, anticonvulsant, muscle relaxant, sedative-hypnotic
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What are some off label uses for benzos?
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IBS, PMS, RLS, essential tremor, CP, spasticity assoc. with various neuro. d/o's - CP, paraplegia
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Where are benzos on the drug schedule?
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schedule IV
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What is versed indicated for?
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induction of sedation
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What is klonopin used for?
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anticonvulsant, tx of panic d/o
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What is the half life of klonopin?
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20-50hrs - once daily dosing
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What is the half life and dosing of xanax and ativan?
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10-20 hrs - tid to qid dosing
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what benzos are preferred in patients with liver disease and the elderly?
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lorazepam, temazepam (restoril), oxazepam
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which benzo has the quickest onset of action?
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diazepam
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Which benzo is preferred for IM injection?
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lorazepam
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What are the "high potency" anxiolytic benzos?
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xanax, ativan, klonopin
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What are some off label uses for benzos?
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IBS, PMS, RLS, essential tremor, CP, spasticity assoc. with various neuro. d/o's - CP, paraplegia
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Where are benzos on the drug schedule?
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schedule IV
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What is versed indicated for?
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induction of sedation
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What is klonopin used for?
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anticonvulsant, tx of panic d/o
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What is the half life of klonopin?
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20-50hrs - once daily dosing
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What are the disadvantages of Benzo's?
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potential for abuse and dependence (less with serax and librium), do not treat depression (can cause depression)
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What is librax a combination of?
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anticholinergic and librium
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What are the advantages of using benzos to treat GAD?
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rapid onset, better efficacy for physical anxiety sx, can be used prn, lower cost, better tolerability
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Side effects of benzos?
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sedation, feeling of tiredness, cognitive impairment, anterograde amnesia, paradoxical reaction, psychomotor effects, respiratory depression, discontinuation syndromes
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T or F? Tolerance to benzos develops more quickly in the elderly.
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False. Tolerance to benzos develops more slowly in the elderly
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What are the discontinuation syndromes?
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addiction, physical dependence, relapse, rebound, withrawal
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What drug can be given to help ease sx of withdrawal from benzos?
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tegretol
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How should you discontinue benzos?
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10 - 25% decrease in dosage every 1-2 weeks
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What are drug interactions with benzos?
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cyp 3a4 inhibitors, alcohol/cns depressants, OCP's
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What are the best choices of benzos for a pregnant woman that has to have them?
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xanax, ativan
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How does buspar work?
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reduces serotonin neurotransmission, enhances dopaminergic neurotransmission
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What are advantages of using buspar to treat GAD?
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no cns depressant effect, no abuse or dependence potential, no sexual dysfunction, may be useful in tx of depression
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How long does it take Buspar to work? What can you give until it begins to take effect?
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1-2 weeks. give benzo for short term relief of sx
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What is first line tx for anxiety d/o's?
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antidepressants
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What can be seen initially when using antidepressants to treat anxiety?
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initial increase in anxiety
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Which SSRI is indicated for all 5 anxiety disorders?
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Paxil
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side effects of paxil?
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sedation, nausea, dry mouth, constipation, asthenia, HA, sexual dysfunction, wt gain
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What was the first antidepressant approved for GAD?
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effexor
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What can be used to treat physical sx of anxiety (tremor, flushing, tachycardia)?
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beta blockers
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side effects of antihistamines?
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sedation, confusion, cognitive impairment, nausea, constipation
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What is the duration of tx for anxiety?
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6-12 months after response
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List all the med classes available to treat anxiety.
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antidepressants (ssri, tca, snri), benzodiazepines, beta blockers, antihistamines
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T or F. You must lower the dose of Buspar in renal or hepatic impairment.
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TRUE
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What is used to treat panic d/o?
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ssri's, tca's, benzo's
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Which ssri's are FDA approved to treat panic d/o?
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paxil, zoloft, prozac
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Which benzos are FDA approved to treat panic d/o?
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xanax XR, klonopin
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What is a disadvantage to using xanax to treat panic d/o?
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short acting --> breakthrough anxiety
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What is the most effective TCA for tx of panic d/o?
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anafranil
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What is used to treat social anxiety d/o?
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antidepressants (paxil, zoloft, effexor), benzos (klonopin, xanax), buspirone (in addition to ssri's)
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