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Anti-Anxiety Drugs Term 5

Terms in this set (39)

When is Anxiety considered a disoder?
Anxiety that becomes excessive, causes irrational thinking or behavior and impairs a person's functioning
What class of drugs are first choice for anxiety?
Antidepressant: SSRI( for GAD, SAD, PTSD, PD, OCD)
How long do antidepressants take to relieve anxiety?
As with treatment of depression may take several weeks (2-4 wks)
Which of the antidepressants is less effective for tx of anxiety?
Bupropion
Why are Benzos recommended for short term or intermittent use in anxiety disorders?
Produce pharmacologic dependence/limited benefit in OCD or PTSD
What are the short term and long term goals of therapy for GAD?
Short term: acutely reduce severity/duration of sxs/restore overall func
Long term: achieve/maintain remission
What are 1st line agents in management of chronic GAD?
Antidepressants
Why are Benzos no long DOC for chronic GAD?
BC their replacements the antidepressants have a tolerable SE profile, no risk for dependency, and efficacy in common comorbid conditions ( depression, panic, OCD, SAD)
Antidepressants reduce what type of sxs of anxiety?
Psychic (worry/apprehension) with modest effect on Autonomic or Somatic sxs (tremor, rapid HR, and/or sweating)
Which antidepressants are preferred over TCAs and why?
Venlafaxine/SSRIs due to improved safety/tolerability
How do you choose a particular antidepressant agent for treating anxiety?
1. Hx of prior response
2. SE profile
3. Drug-interaction profile
4. Cost
5. Formulary availability
Which class of drugs are most effective/commonly used where immediate relief of sxs is desired?
Benzos
What are the indications for Benzos?
1. Acute tx of GAD when short-term relief is needed
2. Adjunct during initiation of antidepressant therapy while
3. Improve sleep
Benzos act [?] but carry the liability of [?]/[?]
1. Quickly
2. Physiologic Dependence
3. Psychologic dependence
How are Benzos used with SSRIs?
Initial adjunct while SSRIs are titrated to an effective dose and they can then be tapered over 4-12 wks while the SSRI is continued
Which drug, considered a 2nd line agent for GAD, does not have abuse potential, withdrawl rxns, potentiate alcohol/sedative-hypnotic effects and provide immediate anxiety relief?
Buspirone
-has gradual onset of action (2 wks)
What are two other alternative agents for GAD?
Hydroxyzine/Pregabalin
What are the main tx objectives for panic disorder?
Short term: To reduce severity/freq of pain attacks, reduce anticipatory anxiety/agoraphobic behavior and minimize sxs of depression or other comorbid disorders
Long term: achieve/sustain remission
What class of drugs are the DOC for Panic Disorder?
SSRIs
Which other class of drugs are effective for Panic disoder when DOC is not effective?
TCA or MAOI
Which class of drugs are used concomitantly w antidepressants esp in early tx or as monotherapy to acute reduce panic sxs in Panic Disorder?
Benzos
Which drug that isn't usu used as long term tx used when pts fail several antidepressant trails in PD?
Benzos
PD pts with comorbid depression should be treated with what?
An antidepressant
Which benzodiazepine tho widely used may cause rebound anxiety bw doses and has associated with what AE?
1. Alprazolam
2. Withdrawl syn (including seizures)
In what age group does Social Anxiety Disorder manifest and what are its effects?
1. Adolescence
2. chronic disorder w significant func impairment/high rates of
comorbidity
What is the goal of acute tx of SAD?
1. To reduce physiologic sxs of anxiety, fear of social situations,
phobic behaviors
2. Pts with comorbid depression should have sig reduction in
depressive sxs
What is the longterm goal in tx SAD?
To restore social functioning/improve pt's quality of life
What class of drugs are DOC for SAD and why?
SSRIs based on their tolerability/efficacy for SAD as well as comorbid disorders
[onset of resp for antidepressants is delayed/may be as long as 8-12 wks]
What are the goals of therapy for obsessive compulsive disorder?
Reduction in freq of obsessive thoughts, in time spent performing compulsive acts, reduction in deg of anxiety
[may not completely eliminate obessions or compulsions but pts feel remarkably improved w partial resolution of their sxs]
What are FDA approved drugs for OCD tx?
Clomipramine
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
[no diff in efficacy bw Clomipramine and SSRIs except that SSRIs have more benign AE profile]
Adding which drugs maybe beneficial in highly anxious OCD pts?
Benzo or Anti-psychotic drug
Define Post Traumatic Stress Disorder.
Manifested when a traumatic or life-threatening event results in intrusive anxiety-provoking thoughts or imagery, hypervigilance, nightmares, and avoidance of situations that remind pt of the trauma
What class of drugs are the major pharmacotherapeutic tx for PTSD?
Antidepressants due to their efficacy in PTSD and concurrent depression/anxiety disorders
What are the 1st antidepressants in pharmacotherapy of PTSD?
SSRIs
What are other antidepressants in pharmacotherapy of PTSD?
Vanlafaxine, TCAs, MAOIs but have less favorable SE profiles
What two drugs are approved for acute tx of PTSD?
Sertraline/Paroxetine
Which drug is approved for long term management of PTSD?
Sertraline
Which class of drugs are used for performance anxiety and why is their used limited?
B-blockers
BC of AE like hypotension
Which two b-blockers are used in treating performance anxiety and why these two particularly?
Propranolol/Nadolol
BC of their higher lipophilicity
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