anxiety disorders

drugs that can cause anxiety

• albuterol (too frequent/incorrect use)

• antipsychotics

• bupropion

• caffeine (high doses)

• decongestants

• illicit drugs

• levothyroxine (therapeutic overdose)

• steroids

• stimulants

• theophylline

natural products used for anxiety

• st john’s wort

• valerian

• passionflower

• kava

first-line meds for anxiety disorders

• SSRIs

  • escitalopram

  • fluoxetine

  • paroxetine

  • sertraline

• SNRIs

  • duloxetine

  • venlafaxine

second-line meds for anxiety disorders

• buspirone

• TCAs

  • amitriptyline

  • nortriptyline

• hydroxyzine

• pregabalin

• gabapentin

what is hydroxyzine and how should it be used for anxiety?

sedating antihistamine

use PRN

what beta blocker do we potentially see being used for physical sx of anxiety?

propranolol (Inderal)

potential MOA of buspirone

affinity for 5-HT1A and 5-HT2 receptors

buspirone CIs/warnings

CI: MAOIs

warnings: serotonin syndrome

buspirone ADRs

• dizziness

• drowsiness

• nausea

buspirone is a ____ substrate

CYP3A4

when do we use benzos for anxiety?

• short-term tx: 1-2 weeks

  • taper off if used longer

• acute anxiety

which benzos are preferred in elderly pts (lower risk of confusion, dizziness, and falls)?

Lorazepam

Oxazepam

Temazepam — not indicated for anxiety

if we use a benzo for anxiety, which should we use?

longer half-life

• lorazepam

• clonazepam

ADRs of benzos

somnolence

dizziness

ataxia

antidote for benzo overdose

flumazenil

what schedule are benzos?

a. C-II

b. C-III

c. C-IV

d. C-V

c. C-IV

what benzodiazepine is CI with strong CYP3A4 inhibitors?

alprazolam