Psychopharm Exam II Study Guide
Anxiolytics
Hello class, as you get through the readings, discussion posts and the resources for this
week, please review the following concepts.
What are the symptoms for SSRI discontinuation syndrome (FINISH)
F= Flu like symptoms (aches, pains, chills)
I= Insomnia
N= Nausea
I= Imbalance
S= Sensory disturbance (tremors, sensation of electrical shock)
H= Hyperarousal
A patient experiencing SSRI related sexual dysfunction
• switch to Wellbutrin
What is the first line agent for anxiety disorders? e.g. Social anxiety disorder (SAD)
***Firstline treatment for chronic anxiety, GAD, panic disorder = SSRI
• Treat comorbid depression
• Lack abuse risk
• Low side effect rate
A patient presents with depressive symptoms alongside pain complaints = what medications
will you consider?
• SSRI’s and TCA’s
Highest anticholinergic effect
• TCA
NOTE: Venlafaxine (Effexor) can be very activating (patients can be restless)
β-adrenergic receptor antagonists (beta-blockers) are generally most effective in the
treatment of Akathisia
Signs of Serotonin Syndrome
, • muscle spasms, fever, racing heart, headache, and confusion
o S=Shivering
o H=Hyperreflexia/Myoclonic jerks
o I = Increased Temp (Fever)
o V= Vitals Instability (↑↓BP; ↑RR; ↑HR)
o E= Encephalopathy (Confusion)
o R= Restlessness
o S= Sweating (Diaphoresis)
Which Serotonergic agent can cause priapism?
• trazodone or escitalopram
Only tricyclic antidepressant (TCA) thought to be effective in the treatment of obsessive
compulsive disorder (OCD)
• clomipramine
Note: Treatment for acute panic attacks = can use benzo short term in addition to long-
term SSRI
Treatment options for various anxiety disorders
• performance anxiety – propranolol
o CBT
o 1st line = SSRI or SNRIs
• GAD – SSRI (escitalopram, paroxetine, duloxetine, venlafaxine)
• SAD – SSRI
• Panic attacks – initially use benzo
• Panic disorder
o 1st line = SSRI, SNRIs
o 2nd line= TCAs= though limited use
o Adjunct = Benzos USE WITH CAUTION, short-term until other meds
reach therapeutic efficacy
▪ alprazolam is FDA approved for panic d/o
• OCD
o Meds + CBT
o 1st line= SSRI (often need high doses of sertraline, fluoxetine); Luvox
o 2nd line = SNRI (e.g. venlafaxine) (Clomipramine=Anafranil)
Benzodiazepines:
Effects of benzodiazepine use; MOA of benzodiazepines (GABA related)
Anxiolytics
Hello class, as you get through the readings, discussion posts and the resources for this
week, please review the following concepts.
What are the symptoms for SSRI discontinuation syndrome (FINISH)
F= Flu like symptoms (aches, pains, chills)
I= Insomnia
N= Nausea
I= Imbalance
S= Sensory disturbance (tremors, sensation of electrical shock)
H= Hyperarousal
A patient experiencing SSRI related sexual dysfunction
• switch to Wellbutrin
What is the first line agent for anxiety disorders? e.g. Social anxiety disorder (SAD)
***Firstline treatment for chronic anxiety, GAD, panic disorder = SSRI
• Treat comorbid depression
• Lack abuse risk
• Low side effect rate
A patient presents with depressive symptoms alongside pain complaints = what medications
will you consider?
• SSRI’s and TCA’s
Highest anticholinergic effect
• TCA
NOTE: Venlafaxine (Effexor) can be very activating (patients can be restless)
β-adrenergic receptor antagonists (beta-blockers) are generally most effective in the
treatment of Akathisia
Signs of Serotonin Syndrome
, • muscle spasms, fever, racing heart, headache, and confusion
o S=Shivering
o H=Hyperreflexia/Myoclonic jerks
o I = Increased Temp (Fever)
o V= Vitals Instability (↑↓BP; ↑RR; ↑HR)
o E= Encephalopathy (Confusion)
o R= Restlessness
o S= Sweating (Diaphoresis)
Which Serotonergic agent can cause priapism?
• trazodone or escitalopram
Only tricyclic antidepressant (TCA) thought to be effective in the treatment of obsessive
compulsive disorder (OCD)
• clomipramine
Note: Treatment for acute panic attacks = can use benzo short term in addition to long-
term SSRI
Treatment options for various anxiety disorders
• performance anxiety – propranolol
o CBT
o 1st line = SSRI or SNRIs
• GAD – SSRI (escitalopram, paroxetine, duloxetine, venlafaxine)
• SAD – SSRI
• Panic attacks – initially use benzo
• Panic disorder
o 1st line = SSRI, SNRIs
o 2nd line= TCAs= though limited use
o Adjunct = Benzos USE WITH CAUTION, short-term until other meds
reach therapeutic efficacy
▪ alprazolam is FDA approved for panic d/o
• OCD
o Meds + CBT
o 1st line= SSRI (often need high doses of sertraline, fluoxetine); Luvox
o 2nd line = SNRI (e.g. venlafaxine) (Clomipramine=Anafranil)
Benzodiazepines:
Effects of benzodiazepine use; MOA of benzodiazepines (GABA related)
