Term
| Most used class for Anxiety disorders? |
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Definition
| SSRIs are the most used for anxiety |
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Term
What can SSRI's or SNRI's be combined with to improve adherence and produce a more rapid response in treating PD?
How long should they be combined? |
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Definition
| Benzos for no longer than 8 weeks can be used. |
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Term
| How can simple stage fright/fear of public speaking be treated ? |
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Definition
| Propranolol (10mg) 30 minutes before the event. |
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Term
Moclobemide - What class is it ?
What type of anxiety should it be used for ?
What dietary restrictions might be in effect and when ?
What side effect is it better for than SSRI's SNRIs ? |
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Definition
Moclobemide - reversible MAOI
Use for SAD only.
If taking over 600mg restrict tyramine in diet (meats, wine, cheeses, beer)
SSRI's SNRI's can cause sexual dysfunction, moclobemide is a good alternative. |
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Term
SSRI's - name them (6)
*
What are the common side effects of SSRI's ?
What type of anxiety are SSRI's good for (general)? |
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Definition
SSRIs - Citalopram, Escitalopram, fluoxitune, fluvoxamine, paroxetime, sertraline.
Common side effects - Nausea, Sexual dysfunction, anticholinergic effects (dry mouth, urinary incontinence, constipation). *BIG* --> GI & CNS, insomnia, anxiety
Good for all types of anxiety. Choose other agents based on side effect profiles. |
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Term
| Drug interactions for SSRIs |
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Definition
MAOIs (serotonin syndrome
Additive effect with other serotonergics.
GI bleeding with NSAIDS or other GI affecting drugs.
Substrate & inhibitor P450s. |
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Term
SSRIs -
Which have fewest drugs interactions (2)?
Which has the most Nausea, constipation & sedation ?
Which causes the most anorexia and stimulating effects?
Which has the longest half-life and therefore requires the longest washout (especially when MAOIs to follow?) What is the washout length?
How long until SSRI's reach maximum effect?
How long do you monitor SSRI's for after the trial period ? |
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Definition
SSRIs
Fewest interactions - citalopram & escitalopram
Most Nausea, constipation & sedation - Fluvoxamine
Most anorexia & stimulating effects?
Fluoxetine
Longest half-life - Fluoxetine (5 week washout when followed by MAOIs)
SSRI's reach maximum effect after 2-3 months.
Monitor SSRI's for 1-2 years. |
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Term
SSRIs -
Most anticholinergic, anxiety, and discontinuation rxn ?
Can be used safely in breastfeeding (2)?
Which cause a discontinuation rxn?
What causes most diarrhea and male sexual dysfunction ? |
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Definition
SSRIs -
Most anticholinergic, anxiety, and discontinuation rxn - paroxetine
Can be used safely in breastfeeding - Sertraline & Paroxetine
Discontinuation rxn - Paroxetine & Venlafaxine.
Most diarrhea & sexual dysfunction - Sertraline |
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Term
Name the SNRI's (2)
Common adverse effects?
How do these adverse effects compare with that of SSRI's ?
What anxiety disorders are they used for ? How efficacious are they compared to SSRIs ? |
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Definition
SNRIs - Duloxetine & Venlafaxine
Common adverse effects - Nausea, insomnia, dizziness, asthenia, Blood pressure increase at high doses, discontinuation syndrome
Compare with SSRI's similar profile, except can increase BP at high doses, and it causes less sexual dysfunction.
Used for GAD or SAD, as efficacious as SSRIs |
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Term
SNRI interactions
*Important dose adjustment factor* |
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Definition
SNRI interactions - subtrate of 3A4, 2D6, 1A2. Serotonergic drug, watch for serotonin syndrome.
Adjust dose for renal function. |
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Term
TCAs - Name the ones used vs Anxiety (3)
Common side effects
Which TCA is best for OCD?
What type of anxiety are TCA's used for?
Which has the least anticholinergic activity? |
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Definition
TCAs - clomipramine, imipramine, desipramine
Side effects - CNS effects, anticholinergic, Cardiovascular effect, anorgasmia
Best for OCD - clomipramine
TCAs most used for PD
Least anticholinergic activity - desipramine |
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Term
Mirtazapine - Noradrenergic and specific serotenergic antidepressant.
What anxiety disorder is it used for?
Side effects?
Drug interactions ? |
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Definition
Mirtazapine
Used for OCD & PTSD
Side effects - decreased sexual dysfunction compared to SSRIs, increases appetite, weight gain, sedation
Drug interactions - Sedation with other antidepressants, do not use with MAOIs and take caution with other serotonergic agents. Substrate of 3A4,2D6,1A2. |
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Term
MAOIs - Name the ones used for anxiety disorders
Adverse events
Interactions
MAIN counseling point
Main anxiety uses |
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Definition
MAOIs - Phenylzine & Tranylcypromine
Adverse events - Sexual dysfunction, orthostatic hypotension, dizziness, Insomnia
Interactions - Serotonergic agents, sympathomimetic agent, tyramine containing foods.
Main counseling point - Avoid tyramine rich foods (beer, wine, cheese) to avoid hypertensive crisis
Used in refractory PD, PDA, OCD |
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Term
Buspirone
What class is it ?
Uses in anxiety
Side effects
Interactions
Special points
approximate cost |
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Definition
Buspirone
class: Azapirone
Uses in anxiety: GAD
Side effects: Nausea, HA, dizziness
Interactions: Avoid MAOIs
When crossing over from benzos taper benzos as there is no cross tolerance
VERY expensive treatment |
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Term
SGAs in anxiety
Which ones can be used, and for which indications? |
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Definition
Risperidone, Quetiapine, Olanzapine
Use as augmentation in PTSD or monotherapy in GAD |
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