PSYCH PART 4.docx

[PSYCH PART 4] [ANXIETY] SSRIs and SNRIs are 1^st^ line treatment for generalized anxiety disorder - Only 4 antidepressants are approved: venlafaxine & duloxetine (SNRIs), paroxetine and escitalopram (SSRIs) Benzos are 1^st^ choice for acute anxiety. Alprazolam, lorazepam, chlordiazepoxide...

[PSYCH PART 4] [ANXIETY] SSRIs and SNRIs are 1^st^ line treatment for generalized anxiety disorder - Only 4 antidepressants are approved: venlafaxine & duloxetine (SNRIs), paroxetine and escitalopram (SSRIs) Benzos are 1^st^ choice for acute anxiety. Alprazolam, lorazepam, chlordiazepoxide, clorazepate, diazepam, ad oxazepam - Sedation and psychomotor slowing will subside in 7-10 days Buspirone (anxiolytic) - Not a CNS depressant. Only for short term tx. - Advantage: No abuse potential and does not intensify the effects of other CNS depressants - Disadvantage: anxiolytic effects are delayed - If switching from benzo to buspirone: benzo must be tapered - Levels can be increased by erythromycin, ketoconazole, and grapefruit juice [PANIC DISORDER] SSRIs are 1^st^ line drugs: fluoxetine, paroxetine, and sertraline OCD - SSRIs: fluoxetine, fluvoxamine, paroxetine, and sertraline - TCAs are 2^nd^ line: clomipramine SOCIAL ANXIETY DISORDER - SSRIs: paroxetine and sertraline - Can also take benzos or betablocker for performance anxiety PTSD - SSRIs: fluoxetine, paroxetine, and sertraline - SNRI: venlafaxine CNS STIMULANTS - Amphetamines - uses: ADHD and narcolepsy - 50:50 compound of dextro and levo - Peripheral actions cardiac stimulation and vasoconstriction - Potential for abuse. - Releases NE and dopamine and inhibition of reuptake - AE: CNS stimulation, weight loss, cv effects, psychosis - Methylphenidate - AE: insomnia, reduced appetite, emotional lability, abuse (schedule II) - Modafinil - A nonamphetamine stimulant - Absorbed in the GI, food decreases rate of absorption, elimination is by hepatic metabolism follow by renal excretion. - Less abuse (schedule IV) - Decreases birth control and cyclosporine [ADHD] - Stimulants are 1^st^ choice (methylphenidate, dexmethylphenidate, dextroamphetamine, lisdexamfetamine) - AE: insomnia and growth suppression reduce size of afternoon dose and taking it no later than 4pm, admin during or after meals - Non-stimulants - Atomoxetine - Inhibitor of NE - Metabolized by the liver - Inhibitors of CYP can increase levels - Guanfacine and clonidine - Not controlled substances and do not cause anorexia or insomnia