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44 Cards in this Set
- Front
- Back
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What disorder has emotional and/or behavioral symptoms within 3 months after an identifiable stressor?
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adjustment disorder
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How do benzos work?
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bind to site on GABAa receptor
keeps receptor open longer (GABA acts as the brakes to the brain) |
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What adverse effect may occur when benzos are combined with alcohol, opiates or barbiturates?
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respiratory depression
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What type of therapy is more difficult with a patient who is on benzos?
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psychotherapy (talking therapy)
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What is the definition of generalized anxiety disorder?
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excessive anxiety and worry more days than not for at least 6 months
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What are two common co-morbid conditions associated with generalized anxiety disorder?
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cardiovascular disease
irritable bowel syndrome |
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What are the best treatments for acute and prophylactic treatment of generalized anxiety disorder?
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acute: benzos
prophylaxis: SSRI |
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What could occur in a patient with GAD if their medication was dosed too high on initiation?
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could worsen anxiety in first week
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What antidepressants could be used for GAD?
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venlafaxine
SSRIs duloxetine imipramine |
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How does buspirone work?
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5HT1a agonist
also affinity for D2 |
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What antidepressant and smoking cessation drug is not good for patients with anxiety?
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bupropion
(dopaminergic) |
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What are the two important pharmacological properties of benzos when treating anxiety?
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low potency
long acting |
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What dose of a benzo usually indicates that it is lower potency?
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a dose >1 mg
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Patients with severe GAD (cant function because of anxiety) could be started on dual therapy with what drugs?
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SSRI
+ Benzo (to treat sx for 3 wks until SSRI kicks in) |
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Panic attacks cause a patient to be nonfunctional, and typically last for how long?
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10 minutes
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A panic disorder is classified by a panic attack that is followed by a month of what 3 things?
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-persistent concern about having additional attacks
-worry about the implication of the attack -significant change in behavior related to the attacks |
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What is the first line treatment for panic disorder?
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antidepressants
(usually potent and at high dose, often take for life) |
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When using an antidepressant to treat panic disorder, how should you dose and titrate?
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start low and increase dose slowly
(need a high dose to treat but increase dose slowly every 2 wks) |
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Giving too high a dose of an SSRI to a patient with panic disorder could result in what?
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inducing a panic attack
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What is the least amount of treatment time of a patient with panic disorder?
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8 wks (and probably 12)
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What are 2 good benzos that can be used to treat acute attacks in panic disorder patients?
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alprazolam
lorazepam |
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What is the difference in timing of symptoms between acute stress disorder and PTSD?
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acute stress disorder: symptoms occur within 4 wks of event
PTSD: symptoms occur at least 4 wks after event |
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Why should benzos be avoided in ASD or PTSD patietns?
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-may use them improperly because they are so distressed
-makes psychotherapy more difficult |
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What medication may treat nightmares in PTSD pts?
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prazosin
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What medication may be someday used to prevent PTSD?
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propranolol
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What drugs may be used as prophylactic symptom treatment along with psychotherapy in pts with ASD or PTSD?
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SSRIs
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What drugs are only used to treat anxiety symptoms in pts with ASD or PTSD?
These are also useful PRN instead of benzos for substance abusers |
gabapentin
tiagabine pregabalin topiramate (antiepileptics) |
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What are the 2 preferred mechanisms of drugs used to treat insomnia?
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-enhancing GABA
-stimulating melatonin |
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What insomnia meds enhance GABA?
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benzos
zolpidem zaleplon eszopiclone barbiturates (unsafe, not recommended) |
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What is the 2nd line mechanism of insomnia meds?
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blocking histamine1 receptors centrally
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What drug stimulates melatonin?
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remelteon (rozerem)
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What histamine blocking drugs are used for insomnia?
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antidepressants
diphenhydramine doxylamine |
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What benzo is better for sleep induction because it is more lipophilic?
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diazepam
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What benzos have the longest half life making them better choices for middle, late, and poor quality insomnia?
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diazepam
chlordiazepoxide |
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What benzos have the shortest half life making them better choices for early insomnia?
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triazolam
oxazepam |
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What benzos are metabolized by CYP450, making them poor choices in liver disease, elderly, and multiple drug users?
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triazolam
alprazolam diazepam chlordiazepoxide |
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Non benzo GABA enhancers used for insomnia are more specific for what receptor?
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GABAa
|
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What are the non-benzo GABA enhancers used to treat insomnia?
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zolpidem (ambien)
zaleplon (sonata) eszopiclone (lunesta) |
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What drug class is a better choice for a patient that has anxiety that is keeping them from sleeping?
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benzo
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What is the most commonly used antidepressant for insomnia?
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trazodone
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Tolerance may develop to what class of drugs if used regularly for treatment of insomnia?
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antihistaminic drugs
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What antihistaminic drugs have anticholinergic effects?
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TCAs
diphyenhydramine doxylamine promethazine hydroxyzine |
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What is the benefit of melatonin agents over benzos in treating insomnia?
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not abusable
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Benzos are more effective then melatonin agents in what aspects of sleep?
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sleep latency
total sleep time |
