Anxiety Flashcards
HPI: LY is a 45 y/o female who presents to her PCP on August 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP but is often resistant to suggestions and advice from healthcare providers.
PMH: HTN, osteoarthritis, allergic rhinitis, asthma, and anxiety
Current Meds (obtained from active Rx bottles on 8/1):
Zestril 10 mg daily
HCTZ 12.5 mg daily
ProAir HFA 2 inhalations Q6H PRN (last 2 refill dates: 7/29, 6/3)
Protonix 40 mg daily
Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop (on day 5 of tx)
Ibuprofen 400 mg daily
Zyrtec D 1 tab BID
Theophylline 300 mg PO daily
Expired Prescriptions and No Refills:
3/25: Xanax 0.5 mg TID x 30 days
3/25: Zoloft 50 mg daily. Disp #30
4/15: Valium 2 mg BID x 5 days
6/1: Lyrica 50 mg TID. Disp #90
Which of the following may be contributing to LY’s anxiety?
a. Use of a systemic steroid
b. Use of a decongestant
c. Frequent use of ProAir HFA
d. Use of theophylline
e. Use of Zestril
a, b, c, d
Drugs that can cause anxiety:
-Albuterol (if used too frequently or incorrectly)
-Antipsychotics (e.g., aripiprazole, haloperidol)
-Bupropion
-Caffeine, in high doses
-Decongestants (e.g., pseudoephedrine)
-Illicit drugs (e.g., cocaine, LSD, meth)
-Levothyroxine (if therapeutic overdose occurs)
-Steroids
-Stimulants (e.g., amphetamine, methylphenidate)
-Theophylline
HPI: LY is a 45 y/o female who presents to her PCP on August 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP but is often resistant to suggestions and advice from healthcare providers.
PMH: HTN, osteoarthritis, allergic rhinitis, asthma, and anxiety
Current Meds (obtained from active Rx bottles on 8/1):
Zestril 10 mg daily
HCTZ 12.5 mg daily
ProAir HFA 2 inhalations Q6H PRN (last 2 refill dates: 7/29, 6/3)
Protonix 40 mg daily
Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop (on day 5 of tx)
Ibuprofen 400 mg daily
Zyrtec D 1 tab BID
Theophylline 300 mg PO daily
Expired Prescriptions and No Refills:
3/25: Xanax 0.5 mg TID x 30 days
3/25: Zoloft 50 mg daily. Disp #30
4/15: Valium 2 mg BID x 5 days
6/1: Lyrica 50 mg TID. Disp #90
Of all the meds that have been prescribed for LY, which is considered first-line to treat a chronic anxiety disorder?
a. Zestril
b. Xanax
c. Valium
d. Zoloft
e. Lyrica
d
The SSRI and SNRI antidepressants are first-line for treating anxiety. BZDs may be appropriate when anxiety is acute or temporary.
HPI: LY is a 45 y/o female who presents to her PCP on August 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP but is often resistant to suggestions and advice from healthcare providers.
PMH: HTN, osteoarthritis, allergic rhinitis, asthma, and anxiety
Current Meds (obtained from active Rx bottles on 8/1):
Zestril 10 mg daily
HCTZ 12.5 mg daily
ProAir HFA 2 inhalations Q6H PRN (last 2 refill dates: 7/29, 6/3)
Protonix 40 mg daily
Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop (on day 5 of tx)
Ibuprofen 400 mg daily
Zyrtec D 1 tab BID
Theophylline 300 mg PO daily
Expired Prescriptions and No Refills:
3/25: Xanax 0.5 mg TID x 30 days
3/25: Zoloft 50 mg daily. Disp #30
4/15: Valium 2 mg BID x 5 days
6/1: Lyrica 50 mg TID. Disp #90
In reviewing LY’s med hx, you find a note from 4/15 that says, “Zoloft 50 mg hasn’t improved anxiety. Switch to Valium.” What is the most likely reason that Zoloft wasn’t effective?
a. It was used alone instead of in combo with a BZD.
b. It was used alone instead of in combo with buspirone.
c. The duration of use may have been too short and the dose too low.
d. The pt was most likely not compliant with the med.
e. It’s not a preferred drug for the tx of anxiety.
c
When used to treat anxiety (and depression), the effects of SSRIs aren’t immediate and may require 4-8 weeks to see an effect at doses in the higher end of the dosing range.
Which of the following meds should be avoided with BZDs according to the BBW for this class of meds?
a. Flexeril
b. Elavil
c. Vistaril
d. Remeron
e. Oxycontin
e
There’s a BBW to avoid the use of opioids with BZDs d/t the risk for sedation, respiratory depression, coma, and death.
BG is an older gentleman who was in a MVA. Previously, BG’s daily meds included nifedipine, simvastatin, aspirin, and tramadol (for generalized arthritis pain). Cyclobenzaprine was added at the time of the accident. D/t the accident and injury, BG has experienced anxiety and was given an Rx for lorazepam to use PRN. He has 1 drink of whiskey at bedtime. The pt is facing a significant risk of the following additive drug interaction problem:
a. HTN
b. Hypotension
c. Bleeding risk
d. Central nervous system stimulation
e. Central nervous system depression
e
When dispensing a BZD, auxiliary labels containing which of the following info should be placed on the bottle?
a. Controlled substance-dangerous unless used as directed
b. May cause anxiety and agitation; use with caution
c. Use alcohol in moderation with this med
d. This drug may impair your ability to drive or operate machinery
e. May cause the skin to burn more easily
a, d
CL is a 76 y/o female who experienced the loss of her spouse this past week. She hasn’t been able to sleep and is acting erratically. Her family is coming for a gathering, and CL is worried about behaving properly. Choose the best BZD for CL to use during the day that will calm her and help her cope during the family gathering:
a. Lorazepam
b. Clonazepam
c. Diazepam
d. Alprazolam
e. Temazepam
a
-Beer’s criteria categorize BZDs as “potentially inappropriate for use in pts aged 65 years and older.”
-For elderly pts, it’s considered safest to choose the “L-O-T” agents (lorazepam, oxazepam, and temazepam) as these are considered less potentially harmful for elderly pts or with liver impairment since they’re metabolized to inactive compounds.
-Of note, temazepam is longer acting and isn’t indicated for anxiety; it’s a hypnotic (sleep agent).
Which of the following natural products can be used to help anxiety?
a. Melatonin
b. Valerian
c. Gingko biloba
d. Saw palmetto
e. Black cohosh
b
-Valerian, kava, St. John’s wort, and passionflower are some common natural meds used for anxiety.
A pt is preparing for a solo piano performance with local symphony orchestra. He’s very anxious and wants to know what he can take to calm his nerves. Which of the following could be recommended?
a. Hydroxyzine
b. Diphenhydramine
c. Propranolol
d. Diltiazem
e. Buspirone
c
-Propranolol is a lipophilic beta-blocker that decreases adrenergic symptoms associated with stage fright or performance anxiety.
-Hydroxyzine can be used for anxiety, but it’s a sedating antihistamine, so it shouldn’t be used for performance anxiety.
