Question 1

An appropriate first-line drug for the treatment of depression with fatigue and low energy would be:&#10;A) Venlafaxine (Effexor)&#10;B) Escitalopram (Lexapro)&#10;C) Buspirone (Buspar)&#10;D) Amitriptyline (Elavil)

Accepted Answer

Venlafaxine (Effexor) is an SNRI (serotonin-norepinephrine reuptake inhibitor) that can be particularly effective in treating depression with associated symptoms of fatigue and low energy, as it targets both serotonin and norepinephrine neurotransmitters, potentially improving energy levels and mood.

Question 2

Common mistakes practitioners make in treating anxiety disorders include:&#10;A) Switching medications after an 8- to 12-week trial&#10;B) Maximizing dosing of anti-anxiety medications&#10;C) Encouraging exercise and relaxation therapy before starting medication&#10;D) Thinking a partial response to medication is acceptable

Accepted Answer

Partial response to medication is not acceptable as it indicates that the medication is not working effectively for the patient. Practitioners should reassess the treatment plan and consider adjusting medication or trying alternative therapies. Switching medications after an 8- to 12-week trial may be appropriate in some cases, but not as a default practice. Maximizing dosing of anti-anxiety medications should be done with caution and under close supervision. Encouraging exercise and relaxation therapy is a helpful addition to treatment, but not a substitute for medication or therapy.

Question 3

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 starting a taper off antidepressants?&#10;A) Change dose to every other day dosing for a week&#10;B) Reduce dose by 50% for 3 to 4 days&#10;C) Reduce dose by 50% every other day&#10;D) Escitalopram (Lexapro)can be stopped abruptly due to its long half-life

Accepted Answer

When tapering off antidepressants, the initial dosage adjustment should be to reduce the dose by 50% for 3 to 4 days before further tapering. This helps to minimize withdrawal symptoms while allowing the body to adjust to the lower dose. Changing the dose to every other day dosing for a week or reducing the dose by 50% every other day can be too drastic and lead to withdrawal symptoms, while stopping abruptly can lead to more severe withdrawal symptoms.

Question 4

An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be:&#10;A) Alprazolam (Xanax)&#10;B) Diazepam (Valium)&#10;C) Buspirone (Buspar)&#10;D) Amitriptyline (Elavil)

Accepted Answer

Buspirone (Buspar) is an appropriate first-line drug to try for mild to moderate generalized anxiety disorder as it has a low risk of addiction and minimal side effects compared to benzodiazepines such as alprazolam or diazepam. Amitriptyline is not typically used for anxiety disorders.

Question 5

An appropriate drug for the treatment of depression with anxiety would be:&#10;A) Alprazolam (Xanax)&#10;B) Escitalopram (Lexapro)&#10;C) Buspirone (Buspar)&#10;D) Amitriptyline (Elavil)

Accepted Answer

Escitalopram (Lexapro) is a selective serotonin reuptake inhibitor (SSRI) that is commonly used for the treatment of both depression and anxiety disorders. It is a first-line treatment for both conditions and has been shown to be effective for the simultaneous treatment of both depression and anxiety. Alprazolam (Xanax) is a benzodiazepine that is primarily used for the treatment of anxiety disorders and is generally not recommended for the treatment of depression. Buspirone (Buspar) is another medication that is primarily used for the treatment of anxiety disorders, but it is not generally considered to be an effective treatment for depression. Amitriptyline (Elavil) is a tricyclic antidepressant that is commonly used for the treatment of depression but is generally not used for the treatment of anxiety disorders, as it has a number of side effects that can be problematic for patients with anxiety.

Question 6

David is a 34 year old who is starting on paroxetine (Paxil)for depression.David's education regarding his medication would include:&#10;A) Paroxetine may cause intermittent diarrhea&#10;B) He may experience sexual dysfunction beginning a month after he starts therapy&#10;C) He may have constipation and he should increase fluids and fiber&#10;D) Paroxetine has a long half-life so he may occasionally skip a dose

Accepted Answer

Sexual dysfunction is a common side effect of paroxetine and it usually occurs after a month of starting the therapy. The other options are either not relevant or not correct.

Question 7

An appropriate drug to initially treat panic disorder is:&#10;A) Alprazolam (Xanax)&#10;B) Diazepam (Valium)&#10;C) Buspirone (Buspar)&#10;D) Amitriptyline (Elavil)

Accepted Answer

The answer of An appropriate drug to initially treat panic...

Question 8

The laboratory monitoring required when a patient is on an SSRI is:&#10;A) Complete blood count every 3 to 4 months&#10;B) Therapeutic blood levels every 6 months after steady state is achieved&#10;C) Blood glucose every 3 to 4 months&#10;D) There is no laboratory monitoring required

Accepted Answer

There is no laboratory monitoring required for patients on SSRIs, as long as they are not experiencing any adverse effects or comorbidities that may warrant monitoring. However, routine follow-up visits with a healthcare provider may be necessary to assess the patient's response to therapy and to check for any emerging side effects or concerns.

Question 9

Prior to starting antidepressants,patients should have laboratory testing to rule out:&#10;A) Hypothyroidism&#10;B) Anemia&#10;C) Diabetes mellitus&#10;D) Low estrogen levels

Accepted Answer

Hypothyroidism can present with symptoms similar to depression, so it is important to rule it out before starting antidepressants. Anemia, diabetes mellitus, and low estrogen levels are not typically associated with depressive symptoms.

Question 10

Jamison has been prescribed citalopram (Celexa)to treat his depression.Education regarding how quickly SSRI antidepressants work would be:&#10;A) Appetite and concentration improve in the first 1 to 2 weeks&#10;B) Sleep should improve almost immediately upon starting citalopram&#10;C) Full response to the SSRI may take 2 to 4 months after he reaches full therapeutic dose&#10;D) His dysphoric mood will improve in 1 to 2 weeks

Accepted Answer

Appetite and concentration are often the first symptoms to improve within the first 1 to 2 weeks of starting an SSRI like citalopram, while mood improvements may take longer.

Deck 29: Anxiety and Depression