What is agoraphobia and how can it be treated? Right Ans - intense fear of
being in public pleases where escape or obtaining help may be difficult
Treat with CBT and SSRI
What treatment is used for generalized anxiety disorder Right Ans - First
line - SSRI
Second line - Buspar (anxiolytic), SNRI
Can consider short term course of benzos or augmentation with buspirone
(Buspar)
SSRI - escitalopram (Lexapro), paroxetine (Paxil),
SNRI - duloxetine (Cymbalta), venlafaxine (Effexor)
What is used to treat panic attacks? Right Ans - initially use benzos short
term
What is used to treat panic disorder? Right Ans - First line- SSRI, SRNA
Second line- TCAs, though limited use
Adjunct - benzo with caution, short-term until SSRIs reach therapeutic efficacy
Alprazolam (Xanax) is FDA approved
SSRI - Fluoxetine (Prozac), Paxil (paroxetine), Zoloft (sertraline),
SNRI - Effexor (venlafaxine)
TCA - clomipramine (Anafranil), imipramine (Tofranil)
What is social phobia and how is it treated? Right Ans - fear of scrutiny by
others or fear of acting in humiliating or embarrassing way
CBT
First line - SSRI or SNRI
Benzos can be used as scheduled or PRN
Beta blockers such as atenolol (50-100 mg) and propranolol (20-40 mg) 1
hour before performance or public speaking
What is used to great specific phobias? Right Ans - CBT with exposure
SSRI - fluvoxamine (Luvox), Paxil (paroxetine), Zoloft (sertraline),
SNRI - Effexor (venlafaxine)
, What is obsessive compulsive disorder (OCD) and how is it treated? Right
Ans - obsessions and/or compulsions that are time consuming, distressing,
and impairing
MEDS + CBT
Fist line- SSRI (often high doses of Zoloft (sertraline). Prozac (Fluoxetine),
Luvox - FDA approved (fluvoxamine) 50-300 mg
2nd line - SNRI Effexor (venlafaxine)
TCA Anafranil (clomipramine) FDA approved
Can augment with atypical antipsychotic in severe cases
ECT in debilitating resistant cases
What is a common side effect of SSRI Luvox (fluvoxamine)? Right Ans -
nausea and vomiting
What are commonly prescribed benzodiazepines? Right Ans - Alprazolam
(Xanax) and lorazepam (Ativan)
What effects does GABA lead to? Right Ans - Potentiate effects of GABA
(GABA is inhibitory and lead to drowsiness, cognitive impairments,
dampening of fear and anxiety, impaired balance, motor control, muscle tone,
and coordination, and anterograde amnesia
Who is at greater risk of fall risk and hip fracture on benzodiazepines?
Right Ans - Elderly patients
What is the mechanism of action for benzodiazepines? Right Ans - enhance
activity of GABA at GABA-A receptors
Why are benzodiazepines not always the best choice of medicatioon Right
Ans - potential for abuse and addition
may become physically dependent
may build tolerance
What can be used to treat akathisia? Right Ans - Benzodiazepines can be
used to treat the uncontrollable urge to move and fidgeting movements
How is choice of BDZ decised? Right Ans - time of onset, duration of action,
and method of metabolism
OTL = metabolized outside the liver (lorazepam, oxazepam, temazepam)
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