ILE 5 Generalized Anxiety Disorder Poll Everywhere

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

Which of the following medications may cause symptoms of anxiety?

prednisone

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

amygdala and CSTC (cortico-striato-thalamo-cortical circuit)

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 what?

tolerance

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

receptor desensitization

What kind of half-life does midazolam have?

ultra short acting

What kind of half-life does diazepam have?

long acting

What kind of half-life does lorazepam have?

intermediate acting

What kind of half-life does oxazepam have?

short acting

How long should hydroxyzine be used to treat anxiety?

4 months

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

How do you initiate sertraline to treat anxiety?

Use one-half to one-quarter of the dose

Benzodiazepines sedative properties occur at

higher doses

Benzodiazepines are anxiolytic

when used at lower doses

Which anxiety scale is self-rated?

Beck Anxiety Scale, Zung Rating Scale, and Generalized Anxiety Scale

What is a barrier to using buspirone as an anxiolytic?

perception that it lacks efficacy

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?

give flumazenil to reverse effects

Which adverse effect is caused by using benzodiazepines during pregnancy?

cleft lip and palate

Which antidepressants cause an initial increase in anxiety?

SSRIs, SNRIs, Vilazodone, and Vortioxetine

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

Buspirone (Buspar)

Which of the following treatments for anxiety is an SSRI?

Fluoxetine (Prozac)

Which of the following treatments for anxiety is an SNRI?

Venlafaxine (Effexor)

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

Clonazepam (Klonopin)

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

60mg

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

lorazepam and diazepam

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

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 diazepam accumulation related to the patients age

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

if used at antidepressant doses, anxiety gets worse before they get better so you need to start low and go slow and use 1/4 to 1/2 of the antidepressant dose to initiate treatment

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

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?

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?

tolerance

Which pharmacokinetic parameter makes a benzodiazepine have higher misuse potential?

shorter time to peak

Are patient laboratories subjective or objective data?

objective

Rating scales are subjective or objective data?

objective

Vital signs are objective or subjective data?

objective

Symptoms are objective or subjective data?

subjective

Which medication is associated with causing anxiety?

fluoxetine, albuterol, caffeine, and pseudoephedrine

Which disease state is associated with anxiety?

asthma, diabetes, IBS, and seizures

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

true

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

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

20

Health literacy is a barrier to care for patients who

keep their medication in their car on a hot day or take their medication intermittently to save money

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

SSRIs

How are benzodiazepines used for anxiety?

as a bridge until antidepressants begin to work

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

feel like they have the flu or feel like something is zapping their brain with an electrical charge

Which anxiety disorder medication should be avoided because of teratogenicity?

paroxetine and diazepam

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

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 patient with a pictorial summary concerning his medication