Anxiety Review Questions 2024
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Questions and Answers

Which of the following statements about SSRIs and SNRIs is correct?

  • They are equally effective for all anxiety disorders, regardless of the specific disorder.
  • They are not commonly used for anxiety disorders.
  • They take 4-6 weeks to reach optimal efficacy for anxiety disorders at therapeutic doses. (correct)
  • They should be started at higher doses for anxiety disorders to achieve faster efficacy.

    • Which of the following is the primary concern regarding gabapentin misuse and abuse, as warned by the FDA?

  • It can cause serious breathing issues, particularly for those with respiratory risk factors such as COPD or elderly age. (correct)
  • It can increase the risk of suicidal thoughts and behaviors, especially in young adults.
  • It can cause severe constipation and intestinal blockages, especially with long-term use.
  • It can lead to severe liver damage when taken with alcohol or other CNS depressants.

    • What is the primary purpose of midazolam?

  • To prevent seizures in patients with epilepsy.
  • To cause drowsiness and relieve anxiety before medical or dental procedures or surgery. (correct)
  • To treat depression and improve mood.
  • To treat insomnia and promote sleep.

    • Which of the following statements best describes the concept of 'cross tolerance' with alcohol and benzodiazepines?

    <p>If a patient has built a tolerance to alcohol, they will also have a high tolerance for benzodiazepines, requiring higher doses of benzodiazepines to be effective.</p> Signup and view all the answers

    Which of the following benzodiazepines do NOT need the 'Do not drink grapefruit juice' label, and why?

    <p>All of the above: Temazepam, Lorazepam, and Oxazepam do not need the 'Do not drink grapefruit juice' label.</p> Signup and view all the answers

    If a patient with an anxiety disorder experiences worsening anxiety after starting an SSRI or SNRI, what is the recommended course of action?

    <p>Decrease the dose of the SSRI or SNRI and monitor the patient's response before considering a dose increase or medication change.</p> Signup and view all the answers

    Which of the following statements is TRUE regarding the use of benzodiazepines in patients with alcohol abuse or dependence?

    <p>Benzodiazepines should be prescribed at lower doses for patients with alcohol abuse or dependence due to the risk of cross-tolerance.</p> Signup and view all the answers

    Which of the following statements accurately describes the relationship between alcohol and benzodiazepines?

    <p>Alcohol and benzodiazepines both act on the GABA A receptor, leading to cross-tolerance between the two substances.</p> Signup and view all the answers

    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

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    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).

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