Ch 35 Drugs for Anxiety

Question 1

Anxiety is an uncomfortable state that has psychologic

manifestations (4) and physical manifestations (8).

Answer 1

fear, apprehension, dread, uneasiness

tachycardia, palpitations, trembling, dry mouth, sweating, weakness, fatigue, shortness of breath

Question 2

When anxiety is (2), intervention is

indicated.

Answer 2

persistent and disabling

Question 3

As a rule, optimal therapy of anxiety disorders consists of

(2).

Answer 3

psychotherapy combined with drug therapy

Question 4

The drugs used most often for anxiety disorders are

(2).

Answer 4

serotonergic reuptake inhibitors and benzodiazepines

Question 5

___ are used primarily for panic disorder (PD) and generalized anxiety disorder (GAD).

___ are used for all anxiety disorders

Answer 5

Benzodiazepines

SRIs

Question 6

GAD (generalized anxiety disorder) is a chronic condition characterized by __.

Answer 6

uncontrollable worrying

Question 7

First-line drugs for GAD are (3).

Answer 7

SRIs, buspirone, and benzodiazepines

Question 8

__ are especially well suited for treating patients who have depression in addition to GAD. However, they are also effective even when depression is absent.

Answer 8

SRIs (venlafaxine, paroxetine, escitalopram, and duloxetine)

Question 9

With buspirone, venlafaxine, paroxetine, escitalopram, and duloxetine, anxiolytic effects are delayed. Accordingly, these drugs are best suited for __.

Answer 9

long-term management—not rapid relief

Question 10

Buspirone has three advantages over benzodiazepines:

Answer 10

It does not cause CNS depression,
has no abuse potential, and
does not intensify the effects of CNS depressants.

Question 11

Buspirone levels can be increased by (3).

Answer 11

erythromycin, ketoconazole, and grapefruit juice

Question 12

Benzodiazepines suppress symptoms of GAD __.

Answer 12

immediately.

Accordingly, these drugs are preferred agents for rapid stabilization, especially when anxiety is severe.

Question 13

__ are CNS depressants and hence can
cause sedation and psychomotor slowing. In addition,
they can intensify CNS depression caused by other
drugs.

Answer 13

Benzodiazepines

Question 14

Benzodiazepines have some potential for abuse, and hence should be used with caution in patients __.

Answer 14

known to abuse alcohol or other psychoactive drugs

Question 15

When taken long term, benzodiazepines can cause __.

Answer 15

physical dependence.

To minimize withdrawal symptoms, dosage should be tapered gradually—over a period of several months.

Question 16

Patients with panic disorder experience recurrent __.

Answer 16

panic attacks, characterized by palpitations, pounding heart, chest pain, derealization or depersonalization, and fear of dying or going crazy

Question 17

Many patients with panic disorder also experience agoraphobia, a condition characterized by __.

Answer 17

anxiety about being in places or situations from which escape might be difficult or embarrassing, or in which help might be unavailable if a panic attack should occur

Question 18

__ are first-line drugs for panic disorder.

Answer 18

SSRIs

Question 19

SSRIs decrease the frequency and intensity of (3), and they work regardless of whether the patient has depression.

Answer 19

panic attacks, anticipatory anxiety, and avoidance behavior

Question 20

Obsessive-compulsive disorder (OCD) is characterized by:

Answer 20

persistent obsessions and compulsions that cause marked distress, consume at least 1 hour a day, and significantly interfere with daily living

Question 21

__ are first-line drugs for OCD.

Answer 21

SSRIs

Question 22

Social anxiety disorder, formerly known as social phobia, is characterized by __.

Answer 22

an intense, irrational fear of being scrutinized by others or of doing something that could be embarrassing or humiliating

Question 23

The __ are first-line drugs for most patients with social

anxiety disorder.

Answer 23

SSRIs

Question 24

When social anxiety disorder is limited to fear of speaking or performing in public and when these situations arise infrequently, PRN treatment with a __ may be preferred to long-term treatment with an SSRI.

Answer 24

benzodiazepine

Question 25

Post-traumatic stress disorder (PTSD) develops following

a __.

Answer 25

traumatic event that elicited an immediate reaction of

fear, helplessness, or horror

Question 26

PTSD has three core symptoms:

Answer 26

re-experiencing,
avoidance/emotional numbing, and
hyperarousal

Question 27

Events that can lead to __ include physical or sexual
assault, rape, torture, combat, industrial explosions, serious accidents, natural disasters, being taken hostage, displacement as a refugee, and terrorist attacks.

Answer 27

PTSD

Question 28

According to a VA/DoD guideline, PTSD can be treated
with _(2)_.

Answer 28

psychotherapy and with drugs

Question 29

__ are approved by the FDA for first-line drug treatment of PTSD. Additional drugs used for treatment of PTSD include venlafaxine (an SNRI), TCAs, and MAOIs.

Answer 29

Two SSRIs (paroxetine and sertraline)