Phobia
GAD
Medications
Sleep
Treatment Strategies
100
All phobic disorders are characterized by disabling anxiety and this.
What is avoidance (pg 456).
100
Two anticonvulsants wjth evidence to support use in treatment of GAD (mentioned in this text).
What is Pregabalin (4 double blind, placebo controlled trials) and Tiagabine (SGRI, randomized, open label study, 20 patients). (p475-76). What about Neurontin?
100
The first agent found to provide sustained efficacy in a 6 month, double blind, placebo-controlled trial for treatment of sleep difficulties.
What is Eszopiclone (Lunesta). After 1 week, 3mg of eszopiclone was superior to placebo in reducing time to sleep onset and improving sleep mainenance, total sleep time, and quality of sleep. Subjective improvements in daytime alertness, sense of well being, and functioning were also reported. These benefits were reported to persist for 6 months. (p487)
100
Characterized by excessive daytime sleepiness for at least one month that is not accounted for by an inadequate amount of nighttime sleep.
What is primary hypersomnia. (p459)
100
Initial treatment strategy for chronic (>7-12weeks) insomnia.
What is Ramelteon (8mg q HS) (F12-3 p. 492) A melatonin receptor agonist, unlike melatonin do not produce hypothermia, decreased BP or HR. Highly selective for melatonin 1 and melatonin 2 receptors at doses 4-64mg, with a greater affinity, selectivity, and potency than melatonin and is generally well tolerated. No apparent abuse or dependency potential. FDA approved for sleep onset insomnia. (p. 487)
200
The lifetime prevalence of Social Anxiety Disorder.
What is 7-12%. (p. 478)
200
The most commonly used drugs for the treatment of GAD.
What are benzodiazapines. (p469)
200
According to the text, this medication is rarely beneficial in patients w/ psychosis and may induce paradoxical reactions.
What is temazepam (restoril).
200
This sydrome is seen exclusively in males age 10-25 years, manifested by binge eating alternating with hypersomnic periods.
What is Kleine-Levin syndrome (p459).
200
The treatment of choice for specific phobic conditions.
What is behavioral techniques (systematic desensitization and in vivo exposure). (p478-79)
300
The differential diagnosis for social phobia includes (name 3)
What is Avoidant Personality disorder, Specific Phobia, PD w/ agoraphobia, performance anxiety, separation anxiety, GAD. (Discuss differences, pg 457)
300
Buspar mechanism of action
What is partial 5-HT1A angonism. Note: buspar has no immediate effect on anxiety, may be more effective in relieving cognitive symptoms, doesn not produce disinhibition euphoria, and does not usually cause dependence, and lacks sedative properties and can d/c abruptly w/o w/d sxs. (p474). Slower onset of action: 1-2 weeks, and requires tid dosing. May not be as effective in pts who have previously used a BZD.
300
This BZD as the highest increase of risk for falls in the elderly.
What is flurazepam (long acting BZD's are relatively contraindicated in the elderly becasue they increase the risk of impaired cognitive fxn, falls, and hip fxs.)
300
The most likely parasomnia: person sits up in bed exhibiting signs of intense anxiety and autonomic arousal (tachycardia, rapid breathing and pulse, dilated pupils and sweating) and may be confused or disoriented and unresponsive to comforting guestures.
What is sleep terror disorder. Usually occurs during non-REM sleep that are characterized by EEG delta wave activity. Patients may describe a sense of terror and fragmentary images but are usually unable to recount a complete dream. Morning amnseia for the episode usually occurs. (vs. Nightmare disorder - minimal autonomic arousal during the dream (although may occur upon awakening), occurs during REM, fully alert and oriented and able to give a detailed account of the dream) (p460)
300
According to the text, the initial treatment strategy for acute, severe short-term anxiety.
What is BZD/pregabalin* plus psychotherapy (pg 477 - review F12-1) *not yet FDA approved
400
The treatment of choice for specific phobias.
What is systematic desensitization and in vivo exposure. (p478-479)
400
GAD is characterized by excessive anxiety or worry occurring more days than not for at least 6 months or longer about a number of events and 3 of these additional criteria (name 3 of 6)
What is restlessness, easy fatigability, difficulty concentrating, irritability, muscle tension, disturbed sleep. (ANDICREST)
400
No studies have demonstrated the hypnotic efficacy of BZD sedative hypnotics behond _______ (amount of time).
What is 12 weeks. In studies involving a parallel placebo group, there usually was no difference between active medication and placdebo after 2 to 3 weeks of treatment. (p483) In another study, BZD users were found to have loss of hypnotic effectiveness and substantial suppression of delta and REM sleep. Abrupt discontinuation resulted in recovery from this suppression with no increase in insomnia.
400
Short term use of this medication used for sleep, has been associated with increased risk of behavioral adverse effects including amnesia, hostility reactions, confusion, bizarre behavior, agitation and hallucinations.
What is triazolam. (pg 503). Analysis of cases reported to the FDA's spontaneous AE Reporting System for sxs such as amnesia, confusion, bizarre behavior, agitation, and hallucinations found that rates for triazolam were 22 to 99 times higher than those for temazepam. Even when reports involving triazolam dosages above 0.5mg or other contributing factors were excluded, reporting rates for triazolam were still 4-26x greater. (p503)
400
This medication may be useful for patients experiencing difficulty falling asleep or for those who wake up at night and who have trouble falling back to sleep.
What is Zaleplon (Sonata). Because of its very short half-life (1h). 10mg Zaleplon free of residual hypnotic or sedative effects when administered as little as 2 hours before waking. (pg 486) The recommended 10mg dose does not significantly impair cognitive or psychomotor skills. (p 486)
500
The fear of washing or bathing.
What is ablutophobia.
500
The text author's drug of choice for patients with GAD who have not taken BZD previously.
What is buspar. (p475) What is your drug of choice for GAD?
500
One of the most significant adverse effects of BZD's that patients may not be aware of.
What is cognitive impairment. (pg 493*)
500
Inflamatory reactions and syncope have been associated with discontinuing this medication used for sleep.
What is triazolam or triazolobenzodiazepines. (pg 504) Triazolobenzodiazepines differ from other BZD's in being potent and having specific inhibitors of the binding of platelet-activating factor (PAF) to its receptor. Noting that initial reports of serious adverse effects associated with triazolam included blistering of hands, feet, and tongue, some authors have speculated that effects on PAF mechanisms may account for the higher incidence of certain unusual w/d sxs for these drugs.
500
The most commonly reported withdrawal symptoms of BZD's are: (name 3)
What is - GI symptoms, diaphoresis, tremor, lethargy, dizziness, HA's, increased acuity for sound and smell*, restlessness, insomnia*, irritability*, anxiety*, tinnitus*, feelings of depersonalization. Patients may also experience distressing sxs (whether d/c is abrupt or gradual), including severe prolonged depression, hallucinations, protracted tinnitus*, opisthotonos, choreoathetosis, myoclonus, and bizarre involuntary muscular movements, panic and agoraphobia. (p 494)
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