NUR 630 FINAL EXAM - ANNALISE'S VERSION
c. Buspirone: 1st line
Buspirone is not first line treatment for anxiety. - Answer -Which of the following is an
incorrect pairing of drug:role in the pharmacologic treatment of anxiety?
a. Hydroxyzine: 2nd line
b. SSRI/SNRI: 1st line
c. Buspirone: 1st line
d. Antipsychotics: 2nd line
d. All of the above
GABA, 5HT, and NE have proposed etiology to treat anxiety and depression. - Answer
-Thinking about drug targets, which is true about the pathophysiology of anxiety?
a. GABA is a primary inhibitory neurotransmitter that reduces anxiety.
b. A lack of serotonin can cause an imbalance of neurotransmitters in the brain
c. Chronic overactivity of NE release can cause down-regulation of presynaptic alpha2-
adrenergic receptors increasing presynaptic NE release.
d. All of the above
- BZDs
- Central beta-blockers
- Clonidine - Answer -What types of medications can be used to treat the physiologic
symptoms of anxiety?
SSRIs/SNRIs/other antidepressants
Antipsychotics
Buspirone
Pregabalin - Answer -What types of medications can be used to treat the emotional and
cognitive symptoms of anxiety? (4)
Short term - this prevents physiological and psychological dependence. - Answer -
Benzodiazepines are generally used _______ term for treatment of anxiety.
False: Benzodiazepines should be reduced slowly over several weeks. - Answer -True
or False: No taper is necessary to stop benzodiazepines after extended use.
Lorazepam, oxazepam, and temazepam - Answer -Which benzodiazepines are
preferred in the elderly and patients with renal impairment?
diazepam, clorazepate, and chlordiazepoxide - Answer -Which three benzodiazepines
are metabolized into desmethyldiazepam (DMDZ), which has a half-life of 50-100
hours?
,False - onset is 2-4 weeks, so it must be used continuously to have an effect on anxiety
symptoms. - Answer -True or False: Buspirone can be used to treat GAD as needed.
5HT1a partial agonist - Answer -What is the MOA of buspirone?
Hydroxyzine - Answer -This adjunctive agent for anxiety is on the Beer's list for
anticholinergic side effects, can be used adjunctive for sleep, and can be used
scheduled or as needed.
H1 antagonist - Answer -What is the MOA for hydroxyzine?
Pregabalin - Answer -This adjunctive agent can be used scheduled or as needed to
treat GAD, and is reasonable for use in patients with comorbid chronic pain.
Anticonvulsant - decreases the release of excitatory neurotransmitters (does not work
on GABA like you would think based on the name) - Answer -What is the MOA of
pregabalin?
Clonidine - Answer -This adjunctive agent to treat anxiety has a fast onset and can
decrease physical symptoms of anxiety, especially during withdrawal of opioids. It may
also cause serious side effects such as orhtostatic hypotension and bradycardia, and is
on the Beer's list.
alpha2-agonist at presynaptic auto-receptors which slows presynaptic NE release. -
Answer -What is the MOA of clonidine?
b. Buspirone
A and C are both on the Beer's list and should not be used in elderly patients. - Answer
-Which of the following augmentation therapies would be the best option for an elderly
patient that does not want to start a BZD to help with anxiety symptoms?
a. Clonidine
b. Buspirone
c. Hydroxyzine
b. Can be used on an as-needed basis
Remember: buspirone works on 5HT1a and needs time to downregulate receptors
before there is clinical effect, so it must be used scheduled not prn. - Answer -Which of
the following counseling points about buspirone is incorrect?
a. Can have delayed therapeutic effects
b. Can be used on an as-needed basis
c. SE's such as dizziness, nausea, and headache can occur.
b. Increase paroxetine to 40 mg daily
,SC is currently on a fairly low dose of paroxetine, so we need to maximize the non-
benzo medication she is on for depression/anxiety prior to increasing the BZD dose.
Augmentation/ polypharmacy should be avoided until the patient has been maximized
on their current medications. - Answer -SC presents to the clinic requesting an increase
of her diazepam due to recently experiencing excessive worry, increased irritability,
fatigue, and difficulty with insomnia. Her current med list includes paroxetine 20 mg
daily, diazepam 5 mg BID, and levothyroxine 125 mcg daily. Which of the following is
the best option to treat the patients increased anxiety symptoms?
a. Increase diazepam to 10 mg BID
b. Increase paroxetine to 40 mg daily
c. Continue regimen and add buspirone 7.5 mg BID
D. Streptococcus pyogenes
Remember: Responsible for strep and some skin-infections.
D.Wills said Group A Strep or Group A Beta-hemolytic strep (GAS or GABHS) is most
commonly caused by strep pyogenes about 5 times in 3 minutes in class, so know this.
- Answer -The most common bacterial etiology for pharyngitis is:
A. Escherichia coli
B. Streptococcus pneumoniae
C. Staphylococcus aureus
D. Streptococcus pyogenes
d. 80-90 mg/kg/day - Answer -Dosing amoxicillin for otitis media should be
a. 20-30 mg/kg/day
b. 30-50 mg/kg/day
c. 50-60 mg/kg/day
d. 80-90 mg/kg/day
a. A shorter eustachian tube - Answer -Children are more susceptible to acute otitis
media because of
a. A shorter eustachian tube
b. Reduced immune responses
c. A longer eustachian tube
d. Increased mucosal surfaces
b. A rapid antigen test - Answer -A diagnosis of bacterial pharyngitis can be made
quickly by
a. A throat culture
b. A rapid antigen detection test
c. The presence of an exudate on the tonsils
d. Temperature of 101
c. Haemophilus influenzae - Answer -Recommendations for the use of clavulanic acid
with amoxicillin are directed toward improving coverage for _______________ when
treating acute bacterial rhinosinusitis.
, a. Streptococcus pneumonia
b. Streptococcus pyogenes
c. Haemophilus influenzae
d. Pseudomonas aeruginosa
b. Conjugate vaccine - Answer -Which type of pneumococcal vaccine is recommended
for children to reduce the incidence of otitis media?
a. Polysaccharide vaccine
b. Conjugate vaccine
a. Effusion - Answer -The presence of fluid in the middle ear space is described as a(n)
a. Effusion
b. Fever
c. Clot
d. Mass
b. Discharge from the ear - Answer -Otorrhea refers to
a. Ear pain
b. Discharge from the ear
c. Fever
d. Loss of hearing
d. 102 F - Answer -A high fever from acute bacterial rhinosinusitis is defined as any
temperature above
a. 99 F
b. 100 F
c. 101 F
d. 102 F
c. Direct sinus puncture - Answer -For acute bacterial rhinosinusitis, the etiology can be
determined by
a. Culturing nasal discharge
b. A throat swab
c. Direct sinus puncture
Inflammation of the throat (pharynx)
Remember: Most commonly caused by viruses - Answer -What is pharyngitis?
Bacterial = faster
Viral = slower
Remember: Bacterial is rapid onset with severe throat pain and viral is slower onset with
less severe throat pain. - Answer -Pharyngitis caused by bacteria has a (faster/slower)
onset, whereas viral has a (faster/slower) onset.
c. Buspirone: 1st line
Buspirone is not first line treatment for anxiety. - Answer -Which of the following is an
incorrect pairing of drug:role in the pharmacologic treatment of anxiety?
a. Hydroxyzine: 2nd line
b. SSRI/SNRI: 1st line
c. Buspirone: 1st line
d. Antipsychotics: 2nd line
d. All of the above
GABA, 5HT, and NE have proposed etiology to treat anxiety and depression. - Answer
-Thinking about drug targets, which is true about the pathophysiology of anxiety?
a. GABA is a primary inhibitory neurotransmitter that reduces anxiety.
b. A lack of serotonin can cause an imbalance of neurotransmitters in the brain
c. Chronic overactivity of NE release can cause down-regulation of presynaptic alpha2-
adrenergic receptors increasing presynaptic NE release.
d. All of the above
- BZDs
- Central beta-blockers
- Clonidine - Answer -What types of medications can be used to treat the physiologic
symptoms of anxiety?
SSRIs/SNRIs/other antidepressants
Antipsychotics
Buspirone
Pregabalin - Answer -What types of medications can be used to treat the emotional and
cognitive symptoms of anxiety? (4)
Short term - this prevents physiological and psychological dependence. - Answer -
Benzodiazepines are generally used _______ term for treatment of anxiety.
False: Benzodiazepines should be reduced slowly over several weeks. - Answer -True
or False: No taper is necessary to stop benzodiazepines after extended use.
Lorazepam, oxazepam, and temazepam - Answer -Which benzodiazepines are
preferred in the elderly and patients with renal impairment?
diazepam, clorazepate, and chlordiazepoxide - Answer -Which three benzodiazepines
are metabolized into desmethyldiazepam (DMDZ), which has a half-life of 50-100
hours?
,False - onset is 2-4 weeks, so it must be used continuously to have an effect on anxiety
symptoms. - Answer -True or False: Buspirone can be used to treat GAD as needed.
5HT1a partial agonist - Answer -What is the MOA of buspirone?
Hydroxyzine - Answer -This adjunctive agent for anxiety is on the Beer's list for
anticholinergic side effects, can be used adjunctive for sleep, and can be used
scheduled or as needed.
H1 antagonist - Answer -What is the MOA for hydroxyzine?
Pregabalin - Answer -This adjunctive agent can be used scheduled or as needed to
treat GAD, and is reasonable for use in patients with comorbid chronic pain.
Anticonvulsant - decreases the release of excitatory neurotransmitters (does not work
on GABA like you would think based on the name) - Answer -What is the MOA of
pregabalin?
Clonidine - Answer -This adjunctive agent to treat anxiety has a fast onset and can
decrease physical symptoms of anxiety, especially during withdrawal of opioids. It may
also cause serious side effects such as orhtostatic hypotension and bradycardia, and is
on the Beer's list.
alpha2-agonist at presynaptic auto-receptors which slows presynaptic NE release. -
Answer -What is the MOA of clonidine?
b. Buspirone
A and C are both on the Beer's list and should not be used in elderly patients. - Answer
-Which of the following augmentation therapies would be the best option for an elderly
patient that does not want to start a BZD to help with anxiety symptoms?
a. Clonidine
b. Buspirone
c. Hydroxyzine
b. Can be used on an as-needed basis
Remember: buspirone works on 5HT1a and needs time to downregulate receptors
before there is clinical effect, so it must be used scheduled not prn. - Answer -Which of
the following counseling points about buspirone is incorrect?
a. Can have delayed therapeutic effects
b. Can be used on an as-needed basis
c. SE's such as dizziness, nausea, and headache can occur.
b. Increase paroxetine to 40 mg daily
,SC is currently on a fairly low dose of paroxetine, so we need to maximize the non-
benzo medication she is on for depression/anxiety prior to increasing the BZD dose.
Augmentation/ polypharmacy should be avoided until the patient has been maximized
on their current medications. - Answer -SC presents to the clinic requesting an increase
of her diazepam due to recently experiencing excessive worry, increased irritability,
fatigue, and difficulty with insomnia. Her current med list includes paroxetine 20 mg
daily, diazepam 5 mg BID, and levothyroxine 125 mcg daily. Which of the following is
the best option to treat the patients increased anxiety symptoms?
a. Increase diazepam to 10 mg BID
b. Increase paroxetine to 40 mg daily
c. Continue regimen and add buspirone 7.5 mg BID
D. Streptococcus pyogenes
Remember: Responsible for strep and some skin-infections.
D.Wills said Group A Strep or Group A Beta-hemolytic strep (GAS or GABHS) is most
commonly caused by strep pyogenes about 5 times in 3 minutes in class, so know this.
- Answer -The most common bacterial etiology for pharyngitis is:
A. Escherichia coli
B. Streptococcus pneumoniae
C. Staphylococcus aureus
D. Streptococcus pyogenes
d. 80-90 mg/kg/day - Answer -Dosing amoxicillin for otitis media should be
a. 20-30 mg/kg/day
b. 30-50 mg/kg/day
c. 50-60 mg/kg/day
d. 80-90 mg/kg/day
a. A shorter eustachian tube - Answer -Children are more susceptible to acute otitis
media because of
a. A shorter eustachian tube
b. Reduced immune responses
c. A longer eustachian tube
d. Increased mucosal surfaces
b. A rapid antigen test - Answer -A diagnosis of bacterial pharyngitis can be made
quickly by
a. A throat culture
b. A rapid antigen detection test
c. The presence of an exudate on the tonsils
d. Temperature of 101
c. Haemophilus influenzae - Answer -Recommendations for the use of clavulanic acid
with amoxicillin are directed toward improving coverage for _______________ when
treating acute bacterial rhinosinusitis.
, a. Streptococcus pneumonia
b. Streptococcus pyogenes
c. Haemophilus influenzae
d. Pseudomonas aeruginosa
b. Conjugate vaccine - Answer -Which type of pneumococcal vaccine is recommended
for children to reduce the incidence of otitis media?
a. Polysaccharide vaccine
b. Conjugate vaccine
a. Effusion - Answer -The presence of fluid in the middle ear space is described as a(n)
a. Effusion
b. Fever
c. Clot
d. Mass
b. Discharge from the ear - Answer -Otorrhea refers to
a. Ear pain
b. Discharge from the ear
c. Fever
d. Loss of hearing
d. 102 F - Answer -A high fever from acute bacterial rhinosinusitis is defined as any
temperature above
a. 99 F
b. 100 F
c. 101 F
d. 102 F
c. Direct sinus puncture - Answer -For acute bacterial rhinosinusitis, the etiology can be
determined by
a. Culturing nasal discharge
b. A throat swab
c. Direct sinus puncture
Inflammation of the throat (pharynx)
Remember: Most commonly caused by viruses - Answer -What is pharyngitis?
Bacterial = faster
Viral = slower
Remember: Bacterial is rapid onset with severe throat pain and viral is slower onset with
less severe throat pain. - Answer -Pharyngitis caused by bacteria has a (faster/slower)
onset, whereas viral has a (faster/slower) onset.
