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44 Cards in this Set

  • Front
  • Back
What disorder has emotional and/or behavioral symptoms within 3 months after an identifiable stressor?
adjustment disorder
How do benzos work?
bind to site on GABAa receptor
keeps receptor open longer
(GABA acts as the brakes to the brain)
What adverse effect may occur when benzos are combined with alcohol, opiates or barbiturates?
respiratory depression
What type of therapy is more difficult with a patient who is on benzos?
psychotherapy (talking therapy)
What is the definition of generalized anxiety disorder?
excessive anxiety and worry more days than not for at least 6 months
What are two common co-morbid conditions associated with generalized anxiety disorder?
cardiovascular disease
irritable bowel syndrome
What are the best treatments for acute and prophylactic treatment of generalized anxiety disorder?
acute: benzos
prophylaxis: SSRI
What could occur in a patient with GAD if their medication was dosed too high on initiation?
could worsen anxiety in first week
What antidepressants could be used for GAD?
venlafaxine
SSRIs
duloxetine
imipramine
How does buspirone work?
5HT1a agonist
also affinity for D2
What antidepressant and smoking cessation drug is not good for patients with anxiety?
bupropion
(dopaminergic)
What are the two important pharmacological properties of benzos when treating anxiety?
low potency
long acting
What dose of a benzo usually indicates that it is lower potency?
a dose >1 mg
Patients with severe GAD (cant function because of anxiety) could be started on dual therapy with what drugs?
SSRI
+
Benzo (to treat sx for 3 wks until SSRI kicks in)
Panic attacks cause a patient to be nonfunctional, and typically last for how long?
10 minutes
A panic disorder is classified by a panic attack that is followed by a month of what 3 things?
-persistent concern about having additional attacks
-worry about the implication of the attack
-significant change in behavior related to the attacks
What is the first line treatment for panic disorder?
antidepressants
(usually potent and at high dose, often take for life)
When using an antidepressant to treat panic disorder, how should you dose and titrate?
start low and increase dose slowly
(need a high dose to treat but increase dose slowly every 2 wks)
Giving too high a dose of an SSRI to a patient with panic disorder could result in what?
inducing a panic attack
What is the least amount of treatment time of a patient with panic disorder?
8 wks (and probably 12)
What are 2 good benzos that can be used to treat acute attacks in panic disorder patients?
alprazolam
lorazepam
What is the difference in timing of symptoms between acute stress disorder and PTSD?
acute stress disorder: symptoms occur within 4 wks of event

PTSD: symptoms occur at least 4 wks after event
Why should benzos be avoided in ASD or PTSD patietns?
-may use them improperly because they are so distressed
-makes psychotherapy more difficult
What medication may treat nightmares in PTSD pts?
prazosin
What medication may be someday used to prevent PTSD?
propranolol
What drugs may be used as prophylactic symptom treatment along with psychotherapy in pts with ASD or PTSD?
SSRIs
What drugs are only used to treat anxiety symptoms in pts with ASD or PTSD?
These are also useful PRN instead of benzos for substance abusers
gabapentin
tiagabine
pregabalin
topiramate
(antiepileptics)
What are the 2 preferred mechanisms of drugs used to treat insomnia?
-enhancing GABA
-stimulating melatonin
What insomnia meds enhance GABA?
benzos
zolpidem
zaleplon
eszopiclone
barbiturates (unsafe, not recommended)
What is the 2nd line mechanism of insomnia meds?
blocking histamine1 receptors centrally
What drug stimulates melatonin?
remelteon (rozerem)
What histamine blocking drugs are used for insomnia?
antidepressants
diphenhydramine
doxylamine
What benzo is better for sleep induction because it is more lipophilic?
diazepam
What benzos have the longest half life making them better choices for middle, late, and poor quality insomnia?
diazepam
chlordiazepoxide
What benzos have the shortest half life making them better choices for early insomnia?
triazolam
oxazepam
What benzos are metabolized by CYP450, making them poor choices in liver disease, elderly, and multiple drug users?
triazolam
alprazolam
diazepam
chlordiazepoxide
Non benzo GABA enhancers used for insomnia are more specific for what receptor?
GABAa
What are the non-benzo GABA enhancers used to treat insomnia?
zolpidem (ambien)
zaleplon (sonata)
eszopiclone (lunesta)
What drug class is a better choice for a patient that has anxiety that is keeping them from sleeping?
benzo
What is the most commonly used antidepressant for insomnia?
trazodone
Tolerance may develop to what class of drugs if used regularly for treatment of insomnia?
antihistaminic drugs
What antihistaminic drugs have anticholinergic effects?
TCAs
diphyenhydramine
doxylamine
promethazine
hydroxyzine
What is the benefit of melatonin agents over benzos in treating insomnia?
not abusable
Benzos are more effective then melatonin agents in what aspects of sleep?
sleep latency
total sleep time