Anxiety Review Questions 2024

Study Notes

Anxiety Disorders Overview

18% of the U.S. population has anxiety disorders.

Generalized Anxiety Disorder (GAD)

Treatment of choice for mild to moderate GAD: Psychotherapy (CBT)
Symptoms of GAD: ICREST (Irritability, Concentration difficulty, Restlessness, Energy low, Sleep disturbances, Tension of the muscles)
Endocrine condition that can cause anxiety: Hyperthyroidism

Medications for Anxiety

4 classes of medications used to treat GAD: SSRIs, SNRIs, Benzodiazepines, Buspirone (Buspar)
Medications that can cause anxiety: CNS stimulants, highly anticholinergic agents, albuterol, excessive corticosteroids
Withdrawal from medications that can cause anxiety: benzodiazepines, alcohol, CNS depressants (opioids)

Benzodiazepines (BZDs)

Pharmacological properties: Anxiolytic, Sedative, Muscle Relaxant, Anticonvulsant
Withdrawal symptoms: Anxiety, Insomnia, Muscle Tension, Seizure
Short-acting BZDs: Triazolam (Halcion), Oxazepam (Serax)
Intermediate-acting BZDs: Temazepam (Restoril), Alprazolam (Xanax), Lorazepam (Ativan), Estazolam (Prosom)
Long-acting BZD: Clonazepam (Klonopin)
BZD to recommend for patients with compromised hepatic function: Lorazepam (Ativan), Oxazepam (Serax), Temazepam (Restoril)
BZD for IM injections: Lorazepam (Ativan)

Interactions and Contraindications

Avoid drinking grapefruit juice with BZDs as it increases blood concentration and risk of side effects
Avoid drinking alcohol with BZDs as it increases sedation and CNS depression

Valium (Diazepam) and Xanax (Alprazolam)

Most likely to be abused due to inducing relaxing effects and high potential
Least likely to be abused: Oxazepam (Serax) due to its hydrophilic properties and less potential for a high

Flumazenil (Romazicon)

Used for reversal agent of monotherapy BZD overdose or effects with procedures requiring midazolam
Should not be recommended in OD of multiple meds

Panic Disorder

Initial dose of SSRIs should be halved due to worsening anxiety symptoms before getting better

Buspirone (Buspar)

Only approved for Generalized Anxiety Disorder (GAD)
Delayed onset of action (2-4 weeks) and should not be used PRN
No sedating, muscle relaxing, or anticonvulsant properties

Vistaril (Hydroxyzine Pamoate)

MOA: Suppression of excessive amygdala activity

Panic Attacks

Often seen in the emergency department as a possible heart attack (myocardial infarction)
Symptoms similar to MI: palpitations or tachycardia, sweating, trembling or shaking, sensations of SOB, feeling of choking, chest pain/discomfort, nausea or abdominal distress, feeling dizzy or faint, fear of dying, paresthesias (numbness or tingling sensations)

Long-term Treatment for Anxiety Disorders

Risk of patient dependency and tolerance to BZDs
SSRIs recommended for long-term treatment for panic disorder

PTSD

Best long-term treatment: Psychotherapy
Off-labeled medication for PTSD nightmares and flashbacks: Prazosin (Minipress)

Phobias

Most common phobia: Public speaking
Propranolol helps with decreasing heart rate, but not with the actual anxiety itself

Description

Test your knowledge on anxiety disorders with these review questions covering topics like prevalence, treatment options, medications that can cause anxiety, and symptoms associated with anxiety. Practice answering true or false questions and identifying appropriate treatments for Generalized Anxiety Disorder (GAD).