Pharmacotherapeutics for Advanced Practice Nurse Prescribers: Chapter 30. Anxiety and Depression

Common mistakes practitioners make in treating anxiety disorders include:

1. Switching medications after an 8- to 12-week trial

2. Maximizing dosing of antianxiety medications

3. Encouraging exercise and relaxation therapy before starting medication

4. Thinking a partial response to medication is acceptable

ANS: 4

An appropriate first-line drug to try for mild to moderate generalized anxiety disorder is:

1. Alprazolam (Xanax)

2. Diazepam (Valium)

3. Buspirone (Buspar)

4. Amitriptyline (Elavil)

ANS: 3

An appropriate drug to initially treat panic disorder is:

1. Alprazolam (Xanax)

2. Diazepam (Valium)

3. Buspirone (Buspar)

4. Amitriptyline (Elavil)

ANS: 2

Prior to starting antidepressants, patients should have laboratory testing to rule out:

1. Hypothyroidism

2. Anemia

3. Diabetes mellitus

4. Low estrogen levels

ANS: 1

David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression. David's education regarding his medication would include:

1. Paroxetine may cause intermittent diarrhea.

2. He may experience sexual dysfunction beginning a month after he starts therapy.

3. He may have constipation and he should increase fluids and fiber.

4. Paroxetine has a long half-life so he may occasionally skip a dose.

ANS: 2

Jamison has been prescribed citalopram (Celexa) to treat his depression. Appropriate education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be:

1. Appetite and concentration improve in the first one to two weeks.

2. Sleep should improve almost immediately upon starting citalopram.

3. Full response to the SSRI may take two to four months after he reaches the full therapeutic dose.

4. His dysphoria will improve in one to two weeks

ANS: 1

An appropriate drug for the treatment of depression with anxiety would be:

1. Alprazolam (Xanax)

2. Escitalopram (Lexapro)

3. Buspirone (Buspar)

4. Amitriptyline (Elavil)

ANS: 2

An appropriate first-line drug for the treatment of depression with fatigue and low energy would be:

1. Venlafaxine (Effexor)

2. Escitalopram (Lexapro)

3. Buspirone (Buspar)

4. Amitriptyline (Elavil)

ANS: 1

The laboratory monitoring required when a patient is on an SSRI is:

1. Complete blood count every three to four months

2. Therapeutic blood levels every six months after a steady state is achieved

3. Blood glucose every three to four months

4. There is no laboratory monitoring required.

ANS: 4

Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the SSRI. What is the initial dosage adjustment when tapering off antidepressants?

1. Change dose to every other day dosing for a week.

2. Reduce dose by 50% for three to four days.

3. Reduce dose by 50% every other day.

4. Escitalopram (Lexapro) can be stopped abruptly due to its long half-life.

ANS: 2

The long-term Xanax patient comes in and states they need a higher dose of the medication. They deny any additional, new, or accelerating triggers of their anxiety. What is the probable reason they want a higher dose?

1. They have become tolerant of the medication, which is characterized by the need for higher and higher doses.

2. They are a drug seeker.

3. They are suicidal.

4. They need additional counseling on lifestyle modification

ANS: 1

What "onset of action" symptoms should be reviewed with patients who have been newly prescribed an SSRI?

1. They will have insomnia for a week.

2. They may feel a bit of nausea, but this will resolve in a week.

3. They will have an "onset seizure" but this is considered normal.

4. They will no longer dream.

ANS: 2

Which of the following should be avoided while taking an SSRI?

1. Aged blue cheese

2. Grapefruit

3. Alcohol

4. Green leafy vegetables

ANS: 3

Why is taking paroxetine (Paxil) consistently and never running out of medication more important with this drug than with most other SSRIs?

1. It has a shorter half-life and withdrawal syndrome has a faster onset without taper.

2. It has the longest half-life and the withdrawal syndrome has a faster onset.

3. It is quasi-addictive in the dopaminergic reward system.

4. It is the most activating of SSRI medications and a sudden stop to taking it will cause the person to have sudden deep sadness.

ANS: 1

The patient shares with the provider that he is taking his Prozac at night before going to bed. What is the best response?

1. This is a good idea because this class of medications generally makes people sleepy.

2. Have you noticed that you are having more sleep issues since you started that?

3. This a good way to remember to take your daily medications because it is near your toothbrush.

4. This is a good plan because you can eat grapefruit as long as Prozac and grapefruit are ingested 8 to 12 hours apart

ANS: 2

Low-dose tricyclic antidepressants taken only at bedtime are routinely used for:

1. Sleep issues

2. Mild depression

3. Restless leg syndrome

4. Acute pain control

ANS: 1

Trazodone has an adverse drug effect in men called:

1. Priapism

2. Gynecomastia

3. Blue vision syndrome

4. Pyronnie Disease

ANS: 1

What herbal supplement must be avoided when taking SSRI or serotonin-norepinephrine reuptake inhibitors (SNRI) medications?

1. Saw palmetto

2. Niacin

3. St. John's Wort

4. Ginseng

ANS: 3

The black box warnings concerning teens and young adults taking antidepressants include:

1. Rapid weight loss

2. Suicidal ideation

3. Growth retardation

4. Increased use of recreational drugs

ANS: 2

Middle-aged women report the following side effect of taking SNRIs and other antidepressants:

1. Increased libido

2. Reduction of hot flashes

3. Easier weight reduction

4. Easier glucose metabolism control

ANS: 2