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| for generalized anxiety disorder must have persistant symtpoms for how long |
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| for GAD pts what will they also normally devlop? |
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| what % of GAD pts achieve remission after 2 yrs of therapy? |
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| panic attacks are slow or fast |
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| how long does a panic attack last |
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| many pts with panic disorder also devlop- |
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| adults require _ symptoms for diagnosis for GAD? children? |
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restless
irritable
muscle tension |
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| for both panic disorder and GAD the symptoms must do what for treatment |
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| for diagnosis of panic disorder what 2 things are needded |
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recurrent unexpected panic attacks
1 attack followed by 1 month of 1 of the 3 symptoms |
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| what are the 3 things a pnaicd disoder attack is followed by in 1 month |
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persistant concern about additional attacks
worry about consequences of attack
change in behavior related to the attack |
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| does a pt need agoraphobia to be diagnosed as panic disorder? |
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| criteria for a panic ATTACK |
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| intense fear with 4 symptoms reaching peak in 10 minutes |
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| look at the symtpoms of panic attack on pg 5 |
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| what are some non pharm therapies for GAD na dpanic disorder-3 |
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psychotherapy
exercise
avoid stimulants (caffeine, nicotine) |
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| what is the primary pharmcotherapy for GAD and panic disorder-2 |
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benzodiazepines
antidepressants |
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| what is the diff in potency of anxiolytic in BDZs |
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BDZs are good fr treating wht symtpoms-2
what symptoms arent they good for? |
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somatic, autonomic
psychiatric |
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| What BDZs are lipophilllic-3 |
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what BDZ has hlaf life of 80 hrs?
which has 40? |
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| what BDZ has short half lives-2 |
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| which BDZ are metabolized thru conjugation-2 |
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| which BDZ is metab thru nitroreduction |
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| most BDZs are metab thru? |
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alprazolam
chlordiazepam
clorazapte
diazepam
lorazapam
oxazepam
clonazepam |
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| in which BDZ is protein binding low-3 |
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Definition
alprazolam
lorazapem
clonazepam |
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| eledry pts experience less side effects with BDZs metabolized by? |
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| BDZs wiht active metabolites cause more ADEs in- |
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| heaptic and elederly (just in general as well) |
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| whihc BDZs have active metablites |
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Definition
chlordiazepoxide
clorazepate
diazepam |
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| pts with hypoalbuminemia (elderly) need what type of BDZs |
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| highly protein bound BDZs can displace what meds?-2 |
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phenytoin
warfarin
(drugs highly protein bound) |
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CNS depression
decreased concentration
abuse potential
anteretrogade amnesia |
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| symptoms of BDZs withdrawl-3 |
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| how do you prevent BDZ withdrawal |
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| decrease by 25% per week til 50% of dose reached, then by 1/8 every 4-7 days |
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| if pt has taekn BZD for less than 8 weeks how long do you taper for? |
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| if pt has taekn BZD for greater than 8 but less than 6 months how long do you taper for? |
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| if pt has taekn BZD for >6 months, less than 1 yr how long do you taper for? |
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| if pt has taekn BZD for more than 1 year how long do you taper for? |
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| BDZs have interaction with what 2 substances- |
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BDZs are metabolizes by?
so inhibitors can do what? |
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| what 2 BDZs are also metabolized by 1A2 |
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| chlordiazepoxide ad diazpeam |
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| star low with BDZs and increase by - |
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| what is the duraiton for acute therapy of BDZs |
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| what pts may need to take BDZs long term? |
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| if dont respond completely to antidepressants |
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| Buspirone doesnt have what properties-3 |
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anticonvulsant
muscle relaxant
hypnotic properties |
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| what ADEs does buspirone not cause?-3 |
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drug depenedncy
motor impairment
sedation |
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| is buspirone as effective as BDZs for chronic GAD management? |
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| how long does it take buspirone to work |
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| which drug shouldnt be sued for acute anxiety?-2 |
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buspirone
anti depressants |
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| is buspirone a first line agent for GAD? |
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| Msd interacitons of buspirone |
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| any that increase CNS serotonin (serotonin syndrome) |
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| go back and look at depresison notes for SSRIs and SNRIs |
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| Duloxetine cna be used for |
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| venalfaxine can be used for-3 |
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| fluoxetine can be used for-2 |
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| paroxetine can be used for-5 |
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GAD
OCD
panic disorder
PTSD
SAD |
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| fluvoxemine can be used for |
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| sertraline can be used fr-4 |
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OCD
panic disorder, PTSD, SAD |
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| escitalopram can be used for |
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| what can be used during any step of GAD algorythm fro therapy |
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acute managment of GAD you should use-
what is the pearl |
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BDZs
consider tapering after 4-6 weeks |
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chronic managmeent of GAD:
Step 1: |
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chronic managmeent of GAD:
Step 2:
no response |
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| switch to antoher SSRI or SNRI |
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chronic managmeent of GAD:
if get partial response you cna add-4 |
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quetapine
BDZ
antihistamine
buspirone |
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chronic managmeent of GAD:
Step 3: try combinging what-4 |
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| SNRI, SSRI, mirtzapine, TCA |
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| duration for chronic GAD should be how long |
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| what can be used at any stage of panic disorder treatment |
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Acute managemnet of panic disorder use-
clincla pearl? |
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Chronic management of panic disorder
Step 1: -2 |
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Definition
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Chronic management of panic disorder
Step 2: |
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| switch to antoher agent from step 1 |
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Chronic management of panic disorder
Step 3:-3 |
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| SSRI, venalfaxine, imipramine |
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Chronic management of panic disorder
Step 4: |
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| duration for chronic panic disorder should be- |
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