Psych TREATMENT OF ANXIETY DISORDERS G

True or False: Approximately 18% of the U.S. population has anxiety disorders.

True

What is the treatment of choice for mild to moderate Generalized Anxiety Disorder (GAD)?

Psychotherapy

Name two medications that can cause anxiety as a side effect.

Sudafed, Benzodiazepines

What are four withdrawal symptoms associated with benzodiazepines?

Anxiety, Insomnia, Muscle tension/tremors, Seizures (AIMS)

Besides excessive worrying, what co-occurring issue might people with GAD experience?

Alcohol use

Which endocrine condition can cause anxiety?

Hyperthyroidism

How is low vitamin D linked to psychiatric disorders?

Increases risk for anxiety and depression

Name the four classes of medications typically used to treat GAD.

SSRIs, SNRIs, Benzodiazepines, Buspirone

What are two pharmacological properties of benzodiazepines (BZDs)?

Tolerance, Dependence

Are withdrawal symptoms more severe with short-acting or long-acting BZDs?

Short-acting

Why do long-acting BZDs result in a smoother withdrawal process?

They accumulate in the body, tapering off more gradually (e.g., Valium up to 200 hours in older adults)

Name the two short-acting benzodiazepines.

Triazolam, Oxazepam

Name the four intermediate-acting benzodiazepines.

Temazepam (Restoril), Alprazolam (Xanax), Lorazepam, Estazolam

Which BZD is long-acting with a half-life of 20–40 hours and no long-acting active metabolite?

Clonazepam

Which three BZDs are recommended for patients with compromised hepatic function?

Lorazepam, Oxazepam, Temazepam (for sleep)

Which BZD is preferred for intramuscular (IM) injections, and why?

Lorazepam (Ativan) – Predictable absorption, available in prepackaged formulations

What two drinks should be avoided with BZDs, and why?

Grapefruit juice (CYP3A4 inhibitor), Alcohol (additive effects)

Why are Valium (diazepam) and Xanax (alprazolam) more likely to be abused?

They cross the blood-brain barrier quickly

Which BZD is least likely to be abused, and why?

Oxazepam – Slower absorption (2–3 hours to peak)

What is flumazenil (Romazicon) used for?

Reverses benzodiazepine effects (e.g., midazolam overdose)

Why might flumazenil not be recommended for all overdoses involving BZDs?

Should be used cautiously, not broadly, due to risks in mixed overdoses

Why might a patient on stable alprazolam develop withdrawal symptoms after starting carbamazepine?

Carbamazepine is an enzyme inducer, lowering alprazolam levels

How long does proper tapering of long-term BZD use typically take?

Weeks to months (10–25% reduction every 1–2 weeks)

What precaution is taken with the initial SSRI dose for panic disorder?

Start low, go slow – temporary worsening of anxiety may occur

Why is bupropion (Wellbutrin) not typically used for anxiety disorders?

Lacks serotonergic properties needed to alleviate anxiety

For which anxiety disorder is Buspirone approved?

Generalized Anxiety Disorder (GAD)

Why isn’t Buspirone 10 mg PO TID PRN effective for anxiety or insomnia?

Takes 2–4 weeks to work, not suitable “as needed” (PRN); only 50% response rate

What is the proposed mechanism of action for Vistaril (hydroxyzine pamoate) as an anxiolytic?

Reduces activity in the amygdala (fear center)

What are four common side effects of Vistaril?

Dry mouth, Constipation, Urinary retention, Blurry vision (anticholinergic)

Which anxiety disorder might be mistaken for a heart attack in the ER, and what symptoms overlap?

Panic attacks – Shortness of breath, Chest pain, Increased heart rate

What is the main issue with long-term BZD use for anxiety?

Leads to tolerance and dependence

What medication class is recommended for long-term treatment of panic disorder?

SSRIs

What is the primary indication for Anafranil (clomipramine)?

Obsessive-Compulsive Disorder (OCD)

What is the best long-term treatment for PTSD, and why might it be challenging initially?

Psychotherapy – Patients avoid traumatic triggers

What off-label medication is used for PTSD nightmares and flashbacks?

Prazosin

What is the most common phobia, and how does propranolol help?

Fear of public speaking – Lowers heart rate to manage physical symptoms

Name two antidepressant classes commonly used for anxiety disorders.

SSRIs, SNRIs

What is the FDA warning about gabapentin?

Potential for misuse and abuse

What is “cross tolerance” between alcohol and benzodiazepines?

Tolerance to alcohol reduces response to BZDs due to shared GABA mechanism

Which benzos dont require grapefruit juice warnings, because they are not significantly metabolized by CYP3A4

Lorazepam, Oxazepam, and Temazepam