Anxiety - FITZ Flashcards
- Anxiety in response to a challenging life event is a
natural response by the body to:
A. help a person focus on the issue at hand.
B. diminish the fight-or-flight response.
C. impair decision making under duress.
D. provide transient improvement in physical capabilities.
A. help a person focus on the issue at hand.
- Which of the following is most consistent with the
diagnosis of generalized anxiety disorder?
A. gastrointestinal upset
B. difficulty initiating sleep
C. diminished cognitive ability
D. consistent early morning wakening
B. difficulty initiating sleep
- Conditions that commonly mimic or can worsen
anxiety include all of the following except:
A. opioid use.
B. thyrotoxicosis.
C. alcohol withdrawal.
D. overuse of caffeine.
A. opioid use.
- When prescribing a benzodiazepine, the NP
considers that:
A. the drugs are virtually interchangeable, with similar
durations of action and therapeutic effect.
B. the onset of therapeutic effect is usually rapid.
C. these drugs have a low abuse potential in substance abusers.
D. elderly adults will likely require doses similar
to those needed by younger adults.
B. the onset of therapeutic effect is usually rapid.
91. The drug buspirone (BuSpar®) has: A. low abuse potential. B. significant antidepressant action. C. a withdrawal syndrome when discontinued, similar to benzodiazepines. D. rapid onset of action.
A. low abuse potential.
- A 24-year-old woman has a new onset of panic disorder.
As part of her clinical presentation, you expect to find all of following except:
A. peak symptoms at 10 minutes into the panic attack.
B. history of agoraphobia.
C. report of chest pain during panic attack.
D. history of thought disorder.
D. history of thought disorder.
93. As you develop the initial treatment plan for a woman with panic disorder, you consider prescribing: A. carbamazepine (Tegretol®). B. risperidone (Risperdal®). C. citalopram (Celexa®). D. bupropion (Wellbutrin®).
C. citalopram (Celexa®).
94. Diagnostic criteria for generalized anxiety disorder include all of the following except: A. difficulty concentrating. B. consistent early morning wakening. C. apprehension. D. irritability
B. consistent early morning wakening.
95. Which of the following is often reported by individuals with anxiety? A. constipation B. muscle tension C. hive-form skin lesions D. somnolence
B. muscle tension
- Pharmacologic intervention in an anxiety disorder
should be:
A. generally given for about 4 to 6 months.
B. continued for at least 6 months after remission
is achieved.
C. continued indefinitely with a first diagnosis
of the condition.
D. titrated to a highest dose recommended after
symptom relief is achieved.
B. continued for at least 6 months after remission
is achieved.
97. The use of which of the following drugs often mimics generalized anxiety disorder? A. sympathomimetics B. antipsychotics C. anticholinergics D. alpha-beta antagonists
A. sympathomimetics
- When prescribing a benzodiazepine, the NP should consider that:
A. the ingestion of 3 to 4 days of therapeutic dose can
be life-threatening.
B. the medication must be taken at the same hour
every day.
C. concomitant use of alcohol should be
avoided.
D. onset of therapeutic effect takes many days.
C. concomitant use of alcohol should be
avoided.
- A middle-aged woman who has taken a therapeutic dose of lorazepam for the past 6 years wishes to stop taking the medication. You advise her that:
A. she can discontinue the drug immediately
if she believes it no longer helps with her
symptoms.
B. rapid withdrawal in this situation can lead to
tremors and hallucinations.
C. she should taper down the dose of the medication
over the next week.
D. gastrointestinal upset is typically reported during the first week of benzodiazepine withdrawal.
B. rapid withdrawal in this situation can lead to
tremors and hallucinations.
- The mechanism of action of benzodiazepines is as:
A. a mediator of gamma-aminobutyric acid (GABA).
B. an enhancer of serotonin.
C. a dopamine antagonist.
D. a serotonin agonist and dopamine antagonist.
A. a mediator of gamma-aminobutyric acid (GABA).
- When considering the use of benzodiazepines as
adjunctive therapy for generalized anxiety disorder,
an appropriate duration of therapy is not exceeding:
A. 2 weeks.
B. 6 weeks.
C. 3 months.
D. 1 year.
B. 6 weeks.
- Risk of benzodiazepine misuse is minimized by use of:
A. agents with a shorter T1⁄2.
B. the drug as an as-needed rescue medication for
acute anxiety.
C. more lipophilic products.
D. products with long duration of action.
D. products with long duration of action.
- Which of the following statements concerning panic disorder is false?
A. Panic disorder rarely occurs with depression.
B. Up to 4% of the general population suffers from
panic disorder.
C. New-onset panic disorder rarely occurs after
45 years of age.
D. Family history of panic disorder is a risk factor
for the condition.
A. Panic disorder rarely occurs with depression.
- Which of the following is true regarding panic
disorder and agoraphobia?
A. More men than women experience panic disorder
without agoraphobia.
B. More women than men experience panic disorder
without agoraphobia.
C. More men than women experience panic disorder
with agoraphobia.
D. More women than men experience panic disorder
with agoraphobia.
D. More women than men experience panic disorder
with agoraphobia.
105. Concomitant health problems found in a patient with panic disorder often include: A. irritable bowel syndrome. B. thought disorders. C. hypothyroidism. D. inflammatory bowel disease.
A. irritable bowel syndrome.
- When initiating SSRI therapy for a patient with panic disorder, the NP should consider all of the following except:
A. starting with a low dose and slowly escalating doses as necessary.
B. it is preferable to use agents that are more energizing than those that are less energizing.
C. selecting agents with a low rate of insomnia and
akathisia.
D. SSRI therapy can precipitate panic attacks with
early use.
B. it is preferable to use agents that are more energizing than those that are less energizing.
- In providing primary care for a patient with posttraumatic stress disorder (PTSD), you consider that
all of the following are likely to be reported except:
A. agoraphobia.
B. feeling of detachment.
C. hyperarousal.
D. poor recall of the precipitating event
D. poor recall of the precipitating event
- Among the preferred first-line pharmacologic
treatment options for patients with PTSD include
the use of:
A. methylphenidate (Ritalin®).
B. oxazepam (Serax®).
C. lithium carbonate.
D. sertraline.
D. sertraline.
- Which of the following therapeutic agents is
commonly used to help with sleep difficulties
such as insomnia associated with PTSD?
A. duloxetine
B. bupropion
C. mirtazapine
D. zolpidem
C. mirtazapine
110. Which of the following is an over-the-counter herbal preparation used to relieve symptoms of depression? A. valerian root B. melatonin C. kava kava D. St. John’s wort
D. St. John’s wort
111. In treatment-resistant patients with panic disorder, which drug class is occasionally used? A. atypical antipsychotic B. selective dopamine reuptake inhibitor C. monoamine oxidase inhibitor D. neuroleptic
C. monoamine oxidase inhibitor
- In treating a person with panic disorder using an
SSRI, the NP should consider that there is:
A. considerable abuse potential with these
medications.
B. no significant therapeutic advantage over TCAs.
C. a reduction in number and severity of panic attacks.
D. significant toxicity in overdose.
C. a reduction in number and severity of panic attacks.
- Concomitant use of an SSRI with which of the
following herbal products can potentially lead to
serotonin syndrome?
A. St. John’s wort
B. kava kava
C. gingko biloba
D. valerian root
A. St. John’s wort
114. Use of St. John’s wort is known to impact the effectiveness of all of the following medications except: A. oral contraceptives. B. fluoroquinolones. C. cyclosporine. D. select antiretrovirals.
B. fluoroquinolones.
115. High doses or prolonged use of kava kava has been associated with cases of: A. renal impairment. B. hepatotoxicity. C. iron deficiency anemia. D. hyperthyroidism.
B. hepatotoxicity.
Elderly
The use of drugs with a shorter T1⁄2 without active metabolites should be considered, however,
when treating elderly persons.
Products such as diazepam and clonazepam (Klonopin®), with a long T1⁄2
give sustained effect without periods of withdrawal
With drugs with a shorter T1⁄2, such as oxazepam (Serax®),
therapeutic gaps can occur
Psychological benzodiazepine dependency
Psychological benzodiazepine dependency can be
avoided by using a slow-onset product such as clonazepam that has a long T1⁄2.
Panic Disorder
Because of the low abuse potential and favorable adverse effect profile, SSRIs have become the initial treatment of choice for persons with panic disorder.
Panic Disorder
start low, go slow, but get to goal = guide therapy
Agoraphobia
Fear of places and situations that might cause panic, helplessness, or embarrassment.
Agoraphobia is an anxiety disorder that often develops after one or more panic attacks.
Symptoms include fear and avoidance of places and situations that might cause feelings of panic, entrapment, helplessness, or embarrassment.
Treatments include talk therapy and medication.
