1. PHARMACOLOGY TUTORING FOR ANTIANXIETY AGENTS By Alaina Darby

2. Which of the following is true of anxiety? a. Pharmacological intervention is used to cure anxiety b. Anxiety is caused by reduced sympathetic stimulation c. Anxiety is often a protective response to certain events d. Psychological intervention (cognative therapy) address only the symptoms

3. Which of the following is not a type of anxiety disorder? a. OCD b. PTSD c. Simple phobias d. Depression

4. Which of the following is true of generalized anxiety? a. It is a term used to describe chronic, low-grade anxiety b. It is a term used to describe brief, dramatic symptoms of anxiety c. It is a term used to describe recurrent panic attacks d. It is defined as recurring panic attack followed by a month or more of panic disorder

5. Which of the following is a symptom of generalized anxiety disorder that is not shared with depression? a. Inability to relax and sleep b. More easily startled c. Fatigue d. Difficulty concentrating

6. Which of the following is the cardinal symptom of panic disorder? a. Generalized anxiety b. Panic attacks c. Phobias d. Chronic discomfort

7. Stacie is terrified of dogs. Whenever she sees one, her heart immediately begins racing and she starts breathing faster. Recently, she has become so scared of encountering a dog that she tends to avoid going out. Which of the following best describes how the entirety of her symptoms would be classified? a. Panic attack b. Generalized anxiety disorder c. Panic disorder d. Agoraphobia

8. Which of the following is most likely to accompany a diagnosis of panic disorder? a. Alcohol abuse b. Severe depression c. OCD d. Family denial and dysfunction

9. How does neurotransmission in anxiety disorder differ from that in depression? a. Serotonin is decreased in both conditions b. Norepinephrine is increased in both conditions c. Serotonin is increased in anxiety but decreased in depression d. Norepinephrine is increased in anxiety but decreased in depression

10. Into which of the following would lutraphobia (fear of otters) be classified? a. Social phobia b. Simple phobia c. Agoraphobia d. Complex phobia

11. Which of the following is not considered a simple phobia? a. Fear of specific animals b. Fear of heights c. Fear of public speaking d. Fear of enclosed spaces

12. Which of the following is true of OCD? a. It occurs more in males than females b. Performing the compulsive behavior evokes anxiety c. It usually begins in childhood d. It occurs in 1-2% of the population

13. Which of the following not a collateral medical risk of panic disorder? a. Hypertension b. Hyperhidrosis c. Heart attack d. Stroke

14. Which of the following pathophysiological causes of anxiety can be targeted by benzodiazepines? a. Noradrenergic projection system b. Serotonergic projection system c. Limbic system d. Paralimbic cortex

15. In which of the following ways is respiration associated with the feeling anxiety? a. Hypoventilation decreases carbon dioxide in the blood b. Hyperventilation decreases carbon dioxide in the blood c. Hypoventilation increases carbon dioxide in the blood d. Hyperventilation increases carbon dioxide in the blood

16. Which of the following areas of the brain is the source of CNS anxiety response? a. Medial forebrain bundle b. Ventral tegmental area c. Locus coeruleus d. Nucleus accumbens

17. Which of the following is not a physiological response to stress? a. Increased force and rate of heart beat b. Increased blood flow to viscera c. Decreased gastrointestinal motility d. Increased glycogen to glucose conversion

18. Which of the following regulates the locus coeruleus by inhibiting transmission? a. Glutamate b. Glycine c. GABA d. Norepinephrine

19. How does the GABA-A receptor produce it’s effect when GABA binds to its receptor site? a. Chloride channel opens causing hyperpolarization b. Chloride channel opens causing hypopolarization c. Calcium channel opens causing hyperpolarization d. Calcium channel opens causing hypopolarization

20. Which of the following is not true of benzodiazepines? a. They have a wider therapeutic index than barbiturates or ethanol b. They produce nonspecific antianxiety effects c. They are safe in overdose when taken alone d. They have relatively low abuse potential

21. Which of the following requires the lowest dose to produce respiratory death? a. Barbiturates b. Benzodiazepines c. Ethanol d. Tricyclic antidepressants

22. Which of the following benzodiazepines is known as the date rape drug and is outlawed in the US? a. Diazepam b. Midazolam c. Oxazepam d. Flunitrazepam

23. What is true of the difference between the benzodiazepines in terms of half- life? a. 2-ketos have shorter half-lives than 3-hydroxys b. 3-hydroxys have half-lives of approximately 12 hours c. Triazolos have half-lives of longer than 20 hours d. 3-hydroxys have shorter half-lives than triazolos

24. Which of the following is not classified as a 2-keto benzodiazepine? a. Diazepam b. Lorazepam c. Chlordiazepoxide d. Prazepam

25. Which of the following benzodiazepines has the longest duration of action? a. Alprazolam b. Estazolam c. Midazolam d. Flurazepam

26. Which of the following benzodiazepines does not have active metabolization intermediates? a. Diazepam b. Lorazepam c. Chlordiazepoxide d. Nordiazepam

27. Which of the following does not determine CNS duration and action for benzodiazepines? a. Metabolism b. Membrane solubility c. Ion permeability d. Accumulation of metabolites

28. Which of the following determinants of CNS duration and action for benzodiazepines could produce tolerance? a. Rate of ingress and egress from CNS b. Half-life c. Presence of active metabolites and their half-lives d. Frequency and chronicity of dosing

29. Which of the following is not a clinical use for benzodiazepines? a. Stage fright b. Panic disorder c. Seizures d. Sleep disorder

30. Which of the following is consistent between different benzodiazepines? a. The subunit on the GABA receptor to which the molecule binds b. The efficacy of the benzodiazepine drug c. The metabolization process for the molecule d. The lipid solubility of the drug molecule

31. Which of the following benzodiazepines can be used to treat restless leg syndrome? a. Lorazepam b. Diazepam c. Clonazepam d. Alprazolam

32. Which of the following benzodiazepines can be used for procedural amnesia? a. Lorazepam b. Diazepam c. Clonazepam d. Alprazolam

33. Which of the following benzodiazepines can be used for bipolar disorder? a. Lorazepam b. Diazepam c. Clonazepam d. Alprazolam

34. Which of the following is not a potential drug interaction with benzodiazepines? a. Calcium channel blockers b. Proton pump inhibitors c. Contraceptives d. Aspirin e. CNS depressants

35. Which of the following is not a contraindication for using benzodiazepines? a. Myasthenia gravis b. Narrow-angle glaucoma c. Hypertension d. Respiratory insufficiency

36. Which of the following decreases the half-lives of benzodiazepines? a. Cimetidine b. Alcohol c. Rifampin d. Antacids e. Disulfiram

37. Which of the following benzodiazepines is used often for the antegrade amnesia that it produces? a. Alprazolam b. Diazepam c. Midazolam d. Triazolam

38. Sally hates speaking in front of crowds and often has anxiety attacks when she if forced to do so. Which of the following drugs will most likely be prescribed for her condition? a. Mirdazolam b. Alprazolam c. Atenolol d. Imipramine

39. Serotonin has been implicated in all of the following behavioral disorders except which of the following? a. Suicidality b. Anorexia c. Seasonal affective disorder d. Schizophrenia

40. Which of the following is thought to be a possible mechanism through which anxiety occurs? a. Sustaining dopamine release through 5-HT2 receptor stimulation b. 5-HT2 mediated serotonin reuptake into platelets c. Reduced neurotransmission in central serotonergic pathways d. Hypostimulation of 5-HT1A receptors due to decreased serotonin levels

41. Which of the following medications used for various anxiety disorders is not also used to treat depression? a. Fluvoxamine b. Fluoxetine c. Sertraline d. Paroxetine

42. Which of the following is not an off-label use for SSRI’s? a. ADHD b. Insomnia c. Panic disorder d. Seasonal affective disorder

43. Which of the following SSRI’s has the longest half-life? a. Fluvoxamine b. Fluoxetine c. Sertraline d. Paroxetine

44. Which of the following is a side effect of SSRI’s that does not tend to resolve with time? a. Anorexia b. Headache and dizziness c. Decreased libido d. Nausea and vomiting

45. Which of the following SSRI’s is most likely to cause weight gain? a. Fluvoxamine b. Fluoxetine c. Sertraline d. Paroxetine

46. Which of the following SSRI’s has the least drug-drug interactions? a. Citalopram b. Fluvoxamine c. Paroxetine d. Sertraline

47. Which of the following SSRI’s has the most drug-drug interactions? a. Citalopram b. Fluvoxamine c. Paroxetine d. Sertraline

48. What describes the drug interactions of SSRI’s? a. Effects are concentration dependent b. Effects are dose dependent c. SSRI levels are altered by other drugs d. Decrease levels of other drugs

49. Which of the following would be given to a patient that cannot tolerate benzodiazepines or SSRI’s and is a partial 5-HT1A agonist? a. Mirtazapine b. Amitriptyline c. Buspirone d. Pregabalin

50. Which of the following works quickly by reducing calcium flow? a. Mirtazapine b. Amitriptyline c. Buspirone d. Pregabalin

51. Which of the following works by directing serotonin to 5-HT1A but also causes increased sedation and weight gain? a. Mirtazapine b. Amitriptyline c. Buspirone d. Pregabalin

52. Which of the following antipsychotics can be admixed with lorazepam in a parental dosage form for better anxiolytic effects? a. Risperidone b. Aripiprazole c. Quentiapine d. Haloperidol

53. Which of the following drugs is not used often for anxiety because of its danger of fatal overdose in single-agent usage and its contraindication in individuals with cardiac abnormalities, prostatic hyperplasia, narrow-angle glaucoma and a variety of other conditions? a. Benzodiazepines b. Tricyclic antidepressants c. MAOI’s d. Barbiturates

54. Which of the following has a similar mechanism of action to benzodiazepines but with a decreased therapeutic index? a. Tricyclic antidepressants b. Barbiturates c. Phenothiazines d. Opioids

55. Amanda has frequent panic attacks and has been diagnosed with panic disorder. She has just become pregnant, and in order to supplement her calcium intake, she has begun eating more yogurt and cheese. Which of the following medications would be suitable for her? a. Alprazolam b. Tranylcypromine c. Buspirone d. Fluoxetine

56. Daniel has overdosed on benzodiazepines and has been given Flumazenil (Romazicon) to reverse the sedative effects of the overdose. What is it’s mechanism of action? a. Irreversibly inhibits the benzodiazepine binding site on the GABA-A receptor b. Competitively inhibits the benzodiazepine binding site on the GABA-A receptor c. Irreversibly inhibits the benzodiazepine binding site on the GABA-B receptor d. Competitively inhibits the benzodiazepine binding site on the GABA-B receptor