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Anxiety Therapeutics
(Barnes)
60
Pharmacology
Graduate
02/07/2017

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Cards

Term
SNRI not as effective as SSRI
Definition
OCD
Term
1st line treatment
Definition
SSRI/SNRI
Term
2nd line treatment
Definition
TCAs
Buspirone
Term
Buspirone MoA
Definition
Partial agonist at 5HT1A presynaptic receptors
Term
Does not improve mood/depression
Definition
Buspirone
Term
Long term efficacy inconsistent
Definition
Buspirone
Term
Use of BZD within last mo. decreases efficacy
Definition
Buspirone
Term
Avoid in pts with high risk for suicide
Definition
TCAs
Term
Overdose causes arrythmias
Definition
TCAs
Term
3rd line treatment
Definition
MAO-I
Term
Adjunctive/Alternative Treatment
Definition
BZDs, Pregabalin, Atypical Antipsychotics, Trazodone, Mirtazepine, Hydroxyzine, Anticonvulsants, a1 antagonists, a2 agonists
Term
BZD MoA
Definition
Potential inhibitory effects of GABA (allosteric)
Term
Relief of acute somatic and autonomic symptoms, NOT cognitive symptoms
Definition
BZD
Term
Avoid hepatic oxidation in liver disease/elderly
Definition
Lorazepam
Oxazepam
Temazepam
Term
Long half life BZD
Definition
Diazepam
Term
BZD Withdrawal
Definition
Can be life threatening
Seizures
Term
Benefits of stopping BZD
Definition
Improved memory and cognition
Decreased risk for motor vehicle crashes
Decreased risk of hip ractures
Term
Adjunctive drug with immediate onset similar to BZD
Definition
Pregabalin (Lyrica)
Term
Improved outcomes when used with SSRI/SNRI
Definition
Pregabalin (Lyrica)
Term
Use lower doses
Onset 1-2 weeks
Definition
Atypical Antipsychotics
Term
Insomnia comorbidity
Definition
Trazodone
Term
Prn use
Antihistamine
Definition
Hydroxyzine
Term
Adjunctive use in PTSD
Definition
a1 antagonists
a2 agonists
Term
GAD
Time to response
Definition
2-4 weeks for effect
4-6 weeks for full effect
Term
Panic Disorder
Time to response
Definition
Max effect at 6-12 weeks
(At least 2 weeks at current dose
Term
SAD
Time to response
Definition
May see therapy at 4 weeks
Medication trial should be 8-12 weeks
Rarely see full remission
Term
PTSD
Definition
Delay in treatment effect of 8-12 weeks
Requires VERY close follow up
Term
OCD
Definition
Delay in treatment effect of 10-12 weeks
Minimum of 6 weeks at max tolerated dose
Term
Augment partial response with insomnia
Definition
Sedative hypnotic
BZD
Trazodone
Mirtazapine
Term
No response
Definition
Ensure trial of 4-6 weeks
Evaluate for comorbidity
Switch to another first line agent or TCA
Add psychotherapy

Add TCA
Add buspirone
Add BZD
Try/add alternative therapy
Term
TCA not effective
Definition
SAD
Term
Buspirone not effective
Definition
Panic disorder
PTSD
Term
GAD minimum length of therapy
Definition
12 mo.
Term
Panic disorder length of therapy
Definition
12-24 mo.
Term
SAD length of therapy
Definition
Usually longterm/life-long
Term
PTSD length of therapy
Definition
Treat for at least 12 mo. after response
Term
OCD minimum length of therapy
Definition
Minimum 1-2 years
Usually lifelong treatment
Term
DOC in pregnancy
Definition
Citalopram
Fluoxetine
Sertraline
Term
AVOID in pregnancy
Definition
Paroxetine
BZD in 1st trimester
Term
BZDs can be used as monotherapy
Definition
Panic disorder treatment
Term
Aerobic exercise improves
Definition
Panic disorder treatment
Term
Citalopram not as effective as other SSRIs, considered 2nd line
Definition
Panic disorder treatment
Term
2nd line panic disorder treatment
Definition
Citalopram (not as effective as other SSRIs)
Term
2nd line SAD treatment
Definition
Citalopram, fluoxetine
(not as effective as other SSRIs)
Term
Exposure therapy
Definition
SAD treatment
Term
Performance-only SAD
Definition
Beta blockers
Term
Beta blocker effect
Definition
Decrease perception of anxiety
(Tachycardia, sweating, blushing, tremor)
Term
Beta blocker dosages
Definition
Propranolol 10-80mg
Atenolol 25-100mg
Term
Psychotherapy is a MUST
(Cognitive behavioral therapy)
Definition
PTSD
Term
When to start drug therapy in PTSD
Definition
3-4 weeks after trauma
Term
PTSD: May decrease nightmares and insomnia
Definition
a1 antagonist (Prazosin)
Term
a1 antagonist (Prazosin)
Definition
PTSD: May decrease nightmares and insomnia
Term
PTSD: May decrease hypervigilance and re-experiencing symptoms
Definition
Atypical antipsychotics
(Risperidone, Quetiapine)
Term
Atypical antipsychotics
(Risperidone, Quetiapine)
Definition
PTSD: May decrease hypervigilance and re-experiencing symptoms
Term
PTSD: May decrease re-experience symptoms and aggresion
Definition
Anticonvulsants/mood stabilizers
(Divalproex, Carbamazepine, Topiramate, Lamotrigine)
Term
Anticonvulsants/mood stabilizers
(Divalproex, Carbamazepine, Topiramate, Lamotrigine)
Definition
PTSD: May decrease re-experience symptoms and aggresion
Term
Therapeutic doses usually higher
Definition
OCD
Term
SNRI's not 1st line
Definition
OCD
Term
Clomipramine effective (>SSRI?)
Definition
OCD
Term
Amitriptyline, imipramine not effective
Definition
OCD
(Less potent and selective inhibition of 5HT reuptake)
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