NSG 552 PSYCHOPHARMACOLOGY EXAM 2 LATEST ACTUAL
EXAM
What is agoraphobia and how can it be treated? - ANSWER: intense fear of being in
public pleases where escape or obtaining help may be difficult
Treat with CBT and SSRI
What treatment is used for generalized anxiety disorder - ANSWER: First line - SSRI
Second line - Buspar (anxiolytic), SNRI
Can consider short term course of benzos or augmentation with buspirone (Buspar)
SSRI - escitalopram (Lexapro), paroxetine (Paxil),
SNRI - duloxetine (Cymbalta), venlafaxine (Effexor)
What is used to treat panic attacks? - ANSWER: initially use benzos short term
What is used to treat panic disorder? - ANSWER: First line- SSRI, SRNA
Second line- TCAs, though limited use
Adjunct - benzo with caution, short-term until SSRIs reach therapeutic efficacy
Alprazolam (Xanax) is FDA approved
SSRI - Fluoxetine (Prozac), Paxil (paroxetine), Zoloft (sertraline),
SNRI - Effexor (venlafaxine)
TCA - clomipramine (Anafranil), imipramine (Tofranil)
What is social phobia and how is it treated? - ANSWER: fear of scrutiny by others or
fear of acting in humiliating or embarrassing way
CBT
First line - SSRI or SNRI
Benzos can be used as scheduled or PRN
Beta blockers such as atenolol (50-100 mg) and propranolol (20-40 mg) 1 hour
before performance or public speaking
What is used to great specific phobias? - ANSWER: CBT with exposure
SSRI - fluvoxamine (Luvox), Paxil (paroxetine), Zoloft (sertraline),
SNRI - Effexor (venlafaxine)
What is obsessive compulsive disorder (OCD) and how is it treated? - ANSWER:
obsessions and/or compulsions that are time consuming, distressing, and impairing
MEDS + CBT
Fist line- SSRI (often high doses of Zoloft (sertraline). Prozac (Fluoxetine), Luvox - FDA
approved (fluvoxamine) 50-300 mg
2nd line - SNRI Effexor (venlafaxine)
TCA Anafranil (clomipramine) FDA approved
Can augment with atypical antipsychotic in severe cases
ECT in debilitating resistant cases
, What is a common side effect of SSRI Luvox (fluvoxamine)? - ANSWER: nausea and
vomiting
What are commonly prescribed benzodiazepines? - ANSWER: Alprazolam (Xanax)
and lorazepam (Ativan)
What effects does GABA lead to? - ANSWER: Potentiate effects of GABA (GABA is
inhibitory and lead to drowsiness, cognitive impairments, dampening of fear and
anxiety, impaired balance, motor control, muscle tone, and coordination, and
anterograde amnesia
Who is at greater risk of fall risk and hip fracture on benzodiazepines? - ANSWER:
Elderly patients
What is the mechanism of action for benzodiazepines? - ANSWER: enhance activity
of GABA at GABA-A receptors
Why are benzodiazepines not always the best choice of medicatioon - ANSWER:
potential for abuse and addition
may become physically dependent
may build tolerance
What can be used to treat akathisia? - ANSWER: Benzodiazepines can be used to
treat the uncontrollable urge to move and fidgeting movements
How is choice of BDZ decised? - ANSWER: time of onset, duration of action, and
method of metabolism
OTL = metabolized outside the liver (lorazepam, oxazepam, temazepam)
What are side effects of BDZ? - ANSWER: anticholinergic (dry mouth, constipation,
urinary retention, blurred vision, increased HR), unusual behavior4s, hallucinations,
daytime drowsiness, amnesia
What is a known limitation of benzo - ANSWER: rebound insomnia
What are benzodiazepines withdrawal symptoms? - ANSWER: Similar to alcohol
withdrawal
insomnia, anxiety, hand tremors, irritability, anorexia, N/V, Autonomic hyperactivity
(diaphoresis, tachycardia, HTN), tonic-clonic seizures which are life-threatening
Abrupt abstinence after chronic use is life-threatening
How do you stop BZD? - ANSWER: taper 10% total dose each week
"Physical and behavioral taper:
Common strategy to convert from SA to LA to facilitate more comfortable taper
What is the mechanism of action of buspirone (Buspar) - ANSWER: Non-
benzodiazepine
EXAM
What is agoraphobia and how can it be treated? - ANSWER: intense fear of being in
public pleases where escape or obtaining help may be difficult
Treat with CBT and SSRI
What treatment is used for generalized anxiety disorder - ANSWER: First line - SSRI
Second line - Buspar (anxiolytic), SNRI
Can consider short term course of benzos or augmentation with buspirone (Buspar)
SSRI - escitalopram (Lexapro), paroxetine (Paxil),
SNRI - duloxetine (Cymbalta), venlafaxine (Effexor)
What is used to treat panic attacks? - ANSWER: initially use benzos short term
What is used to treat panic disorder? - ANSWER: First line- SSRI, SRNA
Second line- TCAs, though limited use
Adjunct - benzo with caution, short-term until SSRIs reach therapeutic efficacy
Alprazolam (Xanax) is FDA approved
SSRI - Fluoxetine (Prozac), Paxil (paroxetine), Zoloft (sertraline),
SNRI - Effexor (venlafaxine)
TCA - clomipramine (Anafranil), imipramine (Tofranil)
What is social phobia and how is it treated? - ANSWER: fear of scrutiny by others or
fear of acting in humiliating or embarrassing way
CBT
First line - SSRI or SNRI
Benzos can be used as scheduled or PRN
Beta blockers such as atenolol (50-100 mg) and propranolol (20-40 mg) 1 hour
before performance or public speaking
What is used to great specific phobias? - ANSWER: CBT with exposure
SSRI - fluvoxamine (Luvox), Paxil (paroxetine), Zoloft (sertraline),
SNRI - Effexor (venlafaxine)
What is obsessive compulsive disorder (OCD) and how is it treated? - ANSWER:
obsessions and/or compulsions that are time consuming, distressing, and impairing
MEDS + CBT
Fist line- SSRI (often high doses of Zoloft (sertraline). Prozac (Fluoxetine), Luvox - FDA
approved (fluvoxamine) 50-300 mg
2nd line - SNRI Effexor (venlafaxine)
TCA Anafranil (clomipramine) FDA approved
Can augment with atypical antipsychotic in severe cases
ECT in debilitating resistant cases
, What is a common side effect of SSRI Luvox (fluvoxamine)? - ANSWER: nausea and
vomiting
What are commonly prescribed benzodiazepines? - ANSWER: Alprazolam (Xanax)
and lorazepam (Ativan)
What effects does GABA lead to? - ANSWER: Potentiate effects of GABA (GABA is
inhibitory and lead to drowsiness, cognitive impairments, dampening of fear and
anxiety, impaired balance, motor control, muscle tone, and coordination, and
anterograde amnesia
Who is at greater risk of fall risk and hip fracture on benzodiazepines? - ANSWER:
Elderly patients
What is the mechanism of action for benzodiazepines? - ANSWER: enhance activity
of GABA at GABA-A receptors
Why are benzodiazepines not always the best choice of medicatioon - ANSWER:
potential for abuse and addition
may become physically dependent
may build tolerance
What can be used to treat akathisia? - ANSWER: Benzodiazepines can be used to
treat the uncontrollable urge to move and fidgeting movements
How is choice of BDZ decised? - ANSWER: time of onset, duration of action, and
method of metabolism
OTL = metabolized outside the liver (lorazepam, oxazepam, temazepam)
What are side effects of BDZ? - ANSWER: anticholinergic (dry mouth, constipation,
urinary retention, blurred vision, increased HR), unusual behavior4s, hallucinations,
daytime drowsiness, amnesia
What is a known limitation of benzo - ANSWER: rebound insomnia
What are benzodiazepines withdrawal symptoms? - ANSWER: Similar to alcohol
withdrawal
insomnia, anxiety, hand tremors, irritability, anorexia, N/V, Autonomic hyperactivity
(diaphoresis, tachycardia, HTN), tonic-clonic seizures which are life-threatening
Abrupt abstinence after chronic use is life-threatening
How do you stop BZD? - ANSWER: taper 10% total dose each week
"Physical and behavioral taper:
Common strategy to convert from SA to LA to facilitate more comfortable taper
What is the mechanism of action of buspirone (Buspar) - ANSWER: Non-
benzodiazepine
