Management of Anxiety Disorders EAQ

The nurse is assessing a patient diagnosed with a panic disorder. What symptoms indicate the medications have not yet started to be therapeutic? Select all that apply. A. Nausea B. Trembling C. Palpitations D. Orthostatic hypotension E. Dry mouth and constipation

A, B, C Panic disorder is characterized by palpitations, sweating, a pounding heart, trembling or shaking, nausea or abdominal distress, dizziness, chills, paresthesias, and other symptoms. If the patient is displaying these symptoms, the medication is not yet therapeutic.

The nurse identifies which antidepressant as effective in the treatment of generalized anxiety disorder (GAD)? Select all that apply. A. Paroxetine [Paxil] B. Fluoxetine [Prozac] C. Duloxetine [Cymbalta] D. Escitalopram [Lexapro] E. Venlafaxine [Effexor XR]

A, C, D, E Fluoxetine [Prozac] is not approved for the treatment of generalized anxiety disorder (GAD). All the other medications listed are approved for the treatment of GAD.

The nurse is assessing a patient who has been prescribed buspirone [BuSpar] to treat general anxiety disorder. Which adverse effects will the nurse monitor for in the patient? Select all that apply. A. Nausea B. Anxiety C. Sedation D. Dizziness E. Lightheadedness

A, D, E Nausea, dizziness, and lightheadedness are adverse effects of buspirone [BuSpar] caused by the mechanism of action of the drug. Buspirone relieves anxiety and is nonsedating.

A patient is diagnosed with post-traumatic stress disorder (PTSD). What can the patient expect in relation to first-line therapy? Select all that apply A. Psychotherapy B. A tricyclic antidepressant (TCA) C. A monoamine oxidase inhibitor (MAOI) D. A selective serotonin reuptake inhibitor (SSRI) medication E. A serotonin/norepinephrine reuptake inhibitor (SNRI) medication

A, D, E Psychotherapy either alone or along with drug therapy is recommended for PTSD. Regarding drugs, evidence of efficacy is strongest for three SSRIs (fluoxetine, paroxetine, and sertraline) and one SNRI (venlafaxine). Of these four drugs, only two—paroxetine [Paxil] and sertraline [Zoloft]—are FDA-approved to treat PTSD. If none of the first-line drugs is effective, the guidelines suggest several alternatives: mirtazapine, a tricyclic antidepressant (amitriptyline or imipramine) or an MAOI (phenelzine).

A distraught patient is admitted to the emergency department with symptoms of palpitations, tachycardia, chest pain, and shortness of breath that started 30 minutes ago. The physical examination reveals no physiologic basis for the symptoms. Which diagnosis is most likely? A. Panic disorder B. Bipolar disorder C. Clinical depression D. Generalized anxiety disorder

A. Panic disorder Panic disorder is characterized by symptoms similar to those of a myocardial infarction. Patients often fear losing control and dying and also may experience dizziness, nausea, depersonalization, and tingling or numbness in the hands. Generalized anxiety disorder is characterized by excessive worrying about events, but it also can include trembling, muscle tension, restlessness, palpitations, tachycardia, sweating, and clammy hands. Bipolar disorder is characterized by mood swings with periods of mania and depression.

The selective serotonin reuptake inhibitors (SSRIs) are recommended therapy for a number of psychologic disorders. The nurse identifies the SSRIs as effective for the treatment of patients with which psychologic disorders? Select all that apply. A. Depression B. Panic disorder C. Social anxiety disorder D. Post-traumatic stress disorder (PTSD) E. Obsessive-compulsive disorder (OCD)

All of the above

What medication would the nurse anticipate a provider prescribing for treatment of generalized anxiety disorder? A. Phenelzine [Nardil] B. Alprazolam [Xanax] C. Trazodone [Desyrel] D. Amoxapine [Asendin]

B. Alprazolam [Xanax] The approved first-line choices are benzodiazepines, and alprazolam [Xanax] is a benzodiazepine. Trazodone and phenelzine are monoamine oxidase inhibitors (MAOIs). Amoxapine is a tricyclic antidepressant.

A patient with a history of abusing opioid analgesics needs an antianxiety agent. Which medication should the nurse expect to administer? A. Diazepam [Valium] B. Buspirone [BuSpar] C. Venlafaxine [Effexor] D. Escitalopram [Lexapro]

B. Buspirone [BuSpar] Because the potential for abuse is low, buspirone [BuSpar] is a suitable antianxiety agent for this patient. Diazepam [Valium] is contraindicated because benzodiazepines are highly addictive. Venlafaxine [Effexor] is a serotonin-norepinephrine reuptake inhibitor, and escitalopram [Lexapro] is a selective serotonin reuptake inhibitor; both medications have a low potential for abuse and are first-line antidepressant therapies. The nurse does not know whether the patient has depression along with the anxiety, so these drugs are not indicated.

A patient with panic disorder has started on a monoamine oxidase (MAO) inhibitor. What information does the nurse include in the teaching plan? A. This medication may cause heart failure. B. Rise slowly from sitting to standing positions. C. This medication is the primary medication for this disorder. D. Nausea is the most common side effect with this medication.

B. Rise slowly from sitting to standing positions Orthostatic hypotension is very common with this medication, and the patient should rise slowly to prevent dizziness. This medication has several serious side effects, and for this reason is not a first-line medication for this disorder. It does not commonly cause nausea but has quite a few dietary interactions.

A patient is detoxifying from alcohol abuse. Which type of medication is indicated to help the patient manage withdrawal symptoms? A. Phenothiazine B. Benzisoxazole C. Benzodiazepine D. Dibenzoxazepine

C. Benzodiazepine A benzodiazepine is indicated in the management of the clinical manifestations of alcohol withdrawal because of their wide range of therapeutic effects. Dibenzoxazepine, benzisoxazoles, and phenothiazines are antipsychotic agents and are not indicated for alcohol withdrawal.

The nurse obtains a medication history from a patient diagnosed with generalized anxiety disorder who is prescribed buspirone. The nurse recognizes that teaching is needed when the nurse notes that the patient is taking which medication with buspirone? A. Garlic B. Ginseng C. Erythromycin D. St. John's wort

C. Erythromycin Erythromycin increases the levels of buspirone 5- to 13-fold. Garlic, ginseng, and St. John's wort are not included in the medications that increase the effects of buspirone.

A patient has been diagnosed with performance anxiety. The nurse anticipates the use of which drug to treat this psychologic disorder? A. Sertraline [Zoloft] B. Alprazolam [Xanax] C. Propranolol [Inderal] D. Clonazepam [Klonopin]

C. Propranolol [Inderal] Propranolol [Inderal] and other beta blockers can benefit patients with performance anxiety. When taken 1 to 2 hours before a scheduled performance, beta blockers can reduce symptoms caused by autonomic hyperactivity (eg, tremors, sweating, tachycardia, and palpitations). Doses are relatively small (ie, only 10 mg to 80 mg for propranolol).

A patient states, "I have not had any luck with these antianxiety medications after a week. I am stopping them now!" What is the nurse's best response? A. "I will call the healthcare provider." B. "Have you had blood levels checked?" C. "What other medications do you take daily?" D. "These medications may not be therapeutic for several more weeks."

D. "These medications may not be therapeutic for several more weeks." These medications take anywhere from 2 to 12 weeks to become therapeutic. The patient should be encouraged to remain on the medications and not stop them prematurely. There is no need to check blood levels at this time. Assessment of other prescribed medications would have taken place prior to prescribing this medication.