GAD Dr. Jackson poll everywhere

Which of the following medications may cause symptoms of anxiety

Propranolol

Prednisone

Hydroxyzine

Hydrochlorothiazide

Prednisone

Which area of the brain is associated with fear and which area is associated with worry, respectively

Nigrostriatal, tuberoinfundibulum

Amygdala, CSTC

Mesocortical, mesolimbic

Prefrontal cortex and hypothalamic pituitary

Amygdala, CSTC

You drink one beer and feel disinhibited. Your friend drinks a 6 pack of beer and it doesn't seem to have an effect on them. This is an example of

Tolerance

Dependence

Disinhibition

Withdrawal

Tolerance

Match the definition to the term below: Decrease in the response of a drug due to frequent administration

Receptor desensitization

Receptor supersensitivity

Receptor withdrawal

Receptor dependence

Receptor desensitization

What kind of half-life does midazolam have?

Long acting

Short acting

Intermediate acting

Ultra short acting

Ultra short acting (its injection only)

What kind of half-life does diazepam have:

Long acting

Short acting

Intermediate acting

Ultra short acting

Long acting

What kind of half-life does lorazepam have?

Long acting

Short acting

Intermediate acting

Ultra short acting

Intermediate acting

What kind of half-life does oxazepam have?

Long acting

Short acting

Intermediate acting

Ultra short acting

Short acting (poll ev answer, possibly wrong)

How long should hydroxyzine be used to treat anxiety?

2 months

4 months

6 months

Indefinitely

4 months

Why do references state that hydroxyzines use should be limited to four months?

Individuals on hydroxyzine adapt to it and no longer have a response after 4 months

Abuse of hydroxyzine is common after 4 months

Use longer than 4 months can cause a discontinuation syndrome

No studies show that it works any longer than 4 months

No studies show that it works any longer than 4 months

What is paradoxical about using an antidepressant for treating anxiety

Antidepressants cause anxiety

Antidepressants cause depression

Antidepressants cause fatigue and insomnia which are symptoms of anxiety

Antidepressants aren't studied for anxiety

Antidepressants cause anxiety

How do you initiate sertraline to treat anxiety?

Use one-half to one-quarter of the dose

Use the same dose as you would use to initiate depression

You could start at the depression maintenance dose

Don't use sertraline to treat anxiety

Use one-half to one-quarter of the dose (25mg-50mg)

Benzodiazepines sedative properties occur at:

higher doses

lower doses

longer half-lives

shorter half-lives

higher doses

Benzodiazepines are anxiolytic:

When used at higher doses

When used at lower doses

When long half-life agents are used

When short half-life agents are used

When used at lower doses

Which anxiety scale is self-rated?

Zung Rating scale

Hamilton Anxiety Scale

Generalized Anxiety Scale

Beck Anxiety Scale

Zung Rating scale
Generalized Anxiety Scale
Beck Anxiety Scale

Hamilton has to be done by clinician

What is a barrier to using buspirone as an anxiolytic?

It leads to dependance

Perception that it lacks efficacy

Pharmacokinetics

Adverse effects

Perception that it lacks efficacy ('pt can't feel it working', takes 4-6 weeks for therapeutic effects)

You are on rotation in the Emergency Room (ER) when a patient arrives after overdosing on a bottle of benzodiazepines. What should you do first?

Doctors should give naloxone to reverse effects

Give midazolam to reverse effects

Admit the patient and monitor for adverse effects

Give flumazenil to reverse effects

Give flumazenil to reverse effects (reversal agent for overdose emergencies)

Which adverse effect is caused by using benzodiazepines during pregnancy?

Spina bifida

Cardiac defect

Cleft lip and palate

Floppy baby syndrome

Cleft lip and palate

Which adverse effect is caused by using paroxetine (Paxil) during pregnancy?

Cardiac defect

Which antidepressants cause an initial increase in anxiety?

SSRIs

SNRIs

Vilazodone

Vortioxetine

All of the above

All of the above (Vilazodone and Vortioxetine work very similarly to the SSRIs and SNRIs)

Which of the following treatments for GAD is a 5HT1A partial agonist?

Fluoxetine (Prozac)

Venlafaxine (Effexor)

Buspirone (Buspar)

Clonazepam (Klonopin)

Buspirone (Buspar)

Which of the following treatments for anxiety is an SSRI?

Fluoxetine (Prozac)

Venlafaxine (Effexor)

Buspirone (Buspar)

Clonazepam (Klonopin)

Fluoxetine (Prozac)

Which of the following treatments for anxiety is an SNRI?

Fluoxetine (Prozac)

Venlafaxine (Effexor)

Buspirone (Buspar)

Clonazepam (Klonopin)

Venlafaxine (Effexor)

Which of the following treatments for anxiety is a GABA-A receptor agonist?

Fluoxetine (Prozac)

Venlafaxine (Effexor)

Buspirone (Buspar)

Clonazepam (Klonopin)

Clonazepam (Klonopin) (benzo's work on GABA; increases affinity at receptor)

A patient with anxiety is taking lorazepam 12 mg daily. Calculate the equivalent dose of diazepam.

15 mg

20 mg

30 mg

60 mg

60 mg (12mg * 5(potency) = 60mg)

Which benzodiazepine is rapidly and completely absorbed and which is erratically absorbed when given IM?

Lorazepam, diazepam

Clonazepam, chlorazepam

Temazepam, buspirone

Diazepam, lorazepam

Lorazepam (rapid), diazepam (erratic)

A 45 year old is diagnosed with GAD that is significant enough that he cannot get to work and he is at risk of losing his job. When he was 21 he went to rehab for drinking too much alcohol, but he has not used any in 20 years. How would you treat?

Treat with a benzodiazepine for 12 months then discontinue

Treat with a high dose long acting benzodiazepine for 6 months then discontinue

Treat this gentleman with buspirone daily

Treat with an SSRI and use a benzodiazepine for a couple of weeks until SSRI starts to work

Treat with an SSRI and use a benzodiazepine for a couple of weeks until SSRI starts to work

Benzos work rapidly and allow for symptom relief before SSRI 'kicks in' (only use 2-3 weeks until antidepressant begins to work, do not use in pt with substance abuse history unless carefully monitored)

Mr. Jackson, 68, started diazepam five weeks ago and his wife takes him to the ER and states that he got confused, and started falling down over the weekend. Why?

Symptoms are due to dementia

Symptoms are due to a drug interaction

Symptoms are due to diazepam accumulation related to the patients age

Symptoms are due to generalized anxiety disorder

Symptoms are due to diazepam accumulation related to the patients age (long half life, poor liver fxn in older age)

Use LOT in older/elderly patients (lorazepam, oxazepam, temazepam)
d/c benzo if memory loss

Which of the following is true of initiating SSRI's in patients with generalized anxiety disorder?

If used at antidepressant doses anxiety symptoms will get worse before they get better

Start low, go slow

Use 1/4 to 1/2 of the antidepressant dose to initiate treatment

Guidelines state to start with a benzodiazepine first line, and if that doesn't work, use an SSRI.

If used at antidepressant doses anxiety symptoms will get worse before they get better

Start low, go slow

Use 1/4 to 1/2 of the antidepressant dose to initiate treatment

Guidelines say SSRI or SNRI first, not benzo

According to the DSM, which symptoms are associated with GAD?

Delusions, hallucinations, paranoia

Insomnia, fatigue, irritability

Poor appetite, distractability, hyperactivity

Sedation, low sex drive, poor concentration

Insomnia, fatigue, irritability

A patient comes to your clinic and you think that he has GAD. A Beck Anxiety Scale shows he has a score of 24. Four weeks later his score is 8. How would you explain the change in score?

Severe to moderate

Severe to mild

Moderate to mild

Moderate to minimal

went from Moderate to mild

You have noticed that Ms. Brown runs out of her diazepam every 3 weeks. She says she had to increase her dose to treat her GAD. What concept does this refer to?

Misuse

Withdrawal

Dependence

Tolerance

Tolerance!

Which pharmacokinetic parameter makes a benzodiazepine have higher misuse potential?

Longer half-life

Longer time to peak

Shorter time to peak

Shorter half-life

Shorter time to peak (Higher lipophilicity= faster absorption/distribution =shorter time to peak (Tmax) = quicker onset=greater abuse potential)

Rating scales are subjective or objective data?

Subjective data

Objective data

Objective data

Symptoms are objective or subjective data?

Subjective

Vital signs are objective or subjective data?

Objective data

Are patient laboratories subjective or objective data?

Objective

Which medication is associated with causing anxiety?

Fluoxetine

Albuterol

Caffeine

Pseudoephedrine

Fluoxetine
Albuterol
Caffeine
Pseudoephedrine

Which disease state is associated with anxiety

Asthma

Diabetes

Irritable bowel syndrome

Seizures

Asthma
Diabetes
Irritable bowel syndrome
Seizures

A patient comes to clinic complaining of fatigue, insomnia, difficulty concentrating, and muscle tension. How long must the patient have these symptoms to be diagnosed with GAD?

6 months

Men have a greater risk of developing generalized anxiety disorder versus women.

False

Drinking too much caffeine in the form of coffee, energy drinks, or soda can potentially increase anxiety?

True

False

True

A patient in your patient education group does not speak English. What do you do to help provide education to your patient?

Ask patient to leave group

Provide a translator for your patient

Treat the patient like the other patients in the group by providing materials in English

Have a special class just for this patient

Provide a translator for your patient

What symptoms would a patient describe if they have anxiety and their antidepressant is initiated at too high of a dose

Patient describes having fatigue and not feeling rested

Patient describes feeling jittery, like they are coming out of their skin

Patient describes their mind going blank at the worst times

Patient is more irritable than usual

Patient describes feeling jittery, like they are coming out of their skin

The Hamilton Anxiety Scale (HAM-A) is a good rating scale to use in a patient that has which of the following:

Difficulty reading

Non-English speaking

Uses benzodiazepines

Likes to do things independently

Difficulty reading (clinician rated, they don't have to be able to read)

Which Beck Anxiety rating scale score is associated with moderate anxiety?

10

20

30

60

20 (16-25 moderate, >26 severe)

Health literacy is a barrier to care for patients who:

Take their medication intermittently to save money

Keep their medication in their car on a hot day

Take their medication as directed

Experience sedation from their medication

Take their medication intermittently to save money
+
Keep their medication in their car on a hot day

Guidelines recommend which of the following as first line treatment for GAD?

SSRIs

Benzodiazepines

Propranolol

Pregabalin

SSRIs

How are benzodiazepines used for anxiety?

As a first-line treatment for anxiety

As a long term treatment for insomnia caused by anxiety

As a bridge until antidepressants begin to work

Benzodiazepines should never be used for anxiety

As a bridge until antidepressants begin to work

What symptoms would a patient describe if they stop their SSRI too quickly?

They would feel jittery

They would feel like they are going to jump out of their skin

They would feel like something is zapping their brain with an electrical charge

They would feel like they had the flu

They would feel like something is zapping their brain with an electrical charge
+
They would feel like they had the flu
(discontinuation syndrome)
(other answer choices are caused from titration up too quickly)

Which anxiety disorder medication should be avoided because of teratogenicity?

Sertraline

Paroxetine

Diazepam

Fluoxetine

Paroxetine (cardiac defect)
+
Diazepam (cleft lip/palate)

A patient with a history of substance use disorders has anxiety and the physician wants to use a benzodiazepine. What do you suggest?

Never use a benzodiazepine in a patient with substance use disorder

A benzodiazepine can be used in a patient with a current substance use disorder

A benzodiazepine can be used in a patient with a past substance use disorder if they are monitored carefully

An SSRI should be used as a bridge until a benzodiazepine starts to work

A benzodiazepine can be used in a patient with a past substance use disorder if they are monitored carefully

The prescription for anxiety medication you are giving to a patient requires that you provide patient education. When having the patient sign for the medication you realize that he cannot read. What kind of patient education do you provide the patient?

Provide the patient with a written summary of her medication

Provide the patient with the same guide that you provide all patients

Provide patient with a pictorial summary concerning his medication

Provide the patients with a written summary in Spanish

Provide patient with a pictorial summary concerning his medication