Which of the following is considered first-line treatment for panic disorders quizlet

Boxed Warnings: use with opioids can result in extreme sleepiness, respiratory depression, coma, or death

CI: varies among agents, acute narrow angle glaucoma, sleep apnea, severe respiratory insufficiency, significant liver disease,

warnings: anterograde amnesia, CNS depression, extravasation with IV use, potential for abuse, risk in elderly of falls etc, tolerance, withdrawal symptom,taper off slowly

physiological dependence and tolerance develop with chronic use

SE: somnolence, dizziness, weakness, ataxia, lightheadedness

NOTES: All medications are C-IV
all are on PRN schedule for dosing
to avoid withdrawl symptoms taper slowly, patient is at risk for withdrawl symptoms after taking medication for 10 days of more

History of Present Illness: LY is a 45 year old female who presents to her PCP on August 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP, but is often resistant to suggestions and advice from healthcare providers.

Allergies: no known drug allergies

Past Medical History: hypertension, osteoarthritis, allergic rhinitis, asthma, and anxiety

Current Medications (obtained from active prescription bottles on 8/1):
Zestril 10 mg daily
Hydrochlorothiazide 12.5 mg daily
ProAir HFA 2 inhalations Q6H PRN (last two refill dates: 7/29, 6/3)
Protonix 40 mg daily
Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop (on day 5 of treatment)
Ibuprofen 400 mg daily
Zyrtec D 1 tablet BID
Pulmicort Flexhaler 1 inhalation BID
Theophylline 300 mg PO daily

Expired Prescriptions and No Refills:
3/15: Xanax 0.5 mg TID x 30 days. No refills
3/15: Zoloft 50 mg daily. Disp #30. No refills.
4/25: Valium 2 mg BID x 5 days. No refills.
6/1: Lyrica 50 mg TID. Disp #90. No refills

Vitals:
Height: 5'6" Weight: 125 pounds
BP: 152/86 mmHg HR: 95 BPM RR: 13 BPM Temp: 98.5°F Pain: 2/10

Physical Exam:
Neuro: alert and oriented
HEENT: few white plaques on the tongue and inner cheeks
CV: RRR
Abdomen: normal bowel sounds
Extremities: no edema noted, good reflexes

Labs:
Na (mEq/L) = 139 (135 - 145)
K (mEq/L) = 3.1 (3.5 - 5)
Cl (mEq/L) = 100 (95 - 103)
HCO3 (mEq/L) = 25 (24 - 30)
BUN (mg/dL) = 12 (7 - 20)
SCr (mg/dL) = 0.8 (0.6 - 1.3)
Glucose (mg/dL) = 147 (100 - 125)
TSH (mIU/L) = 0.15 (0.3 - 3)
Ca (mg/dL) = 8.8 (8.5 - 10.5)
Albumin (g/dL) = 3.2 (3.5 - 5)
Theophylline peak level (mcg/mL) = 7
Question
Which of the following may be contributing to LY's anxiety? (Select ALL that apply.)
Answer
A
Use of a systemic steroid

B
Use of a decongestant
C
Incorrect use or overuse of albuterol

D
Use of theophylline
E
Use of Pulmicort Flexhaler

History of Present Illness: LY is a 45 year old female who presents to her PCP on August 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP, but is often resistant to suggestions and advice from healthcare providers.

Allergies: no known drug allergies

Past Medical History: hypertension, osteoarthritis, allergic rhinitis, asthma, and anxiety

Current Medications (obtained from active prescription bottles on 8/1):
Zestril 10 mg daily
Hydrochlorothiazide 12.5 mg daily
ProAir HFA 2 inhalations Q6H PRN (last two refill dates: 7/29, 6/3)
Protonix 40 mg daily
Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop (on day 5 of treatment)
Ibuprofen 400 mg daily
Zyrtec D 1 tablet BID
Pulmicort Flexhaler 1 inhalation BID
Theophylline 300 mg PO daily

Expired Prescriptions and No Refills:
3/15: Xanax 0.5 mg TID x 30 days. No refills
3/15: Zoloft 50 mg daily. Disp #30. No refills.
4/25: Valium 2 mg BID x 5 days. No refills.
6/1: Lyrica 50 mg TID. Disp #90. No refills

Vitals:
Height: 5'6" Weight: 125 pounds
BP: 152/86 mmHg HR: 95 BPM RR: 13 BPM Temp: 98.5°F Pain: 2/10

Physical Exam:
Neuro: alert and oriented
HEENT: few white plaques on the tongue and inner cheeks
CV: RRR
Abdomen: normal bowel sounds
Extremities: no edema noted, good reflexes

Labs:
Na (mEq/L) = 139 (135 - 145)
K (mEq/L) = 3.1 (3.5 - 5)
Cl (mEq/L) = 100 (95 - 103)
HCO3 (mEq/L) = 25 (24 - 30)
BUN (mg/dL) = 12 (7 - 20)
SCr (mg/dL) = 0.8 (0.6 - 1.3)
Glucose (mg/dL) = 147 (100 - 125)
TSH (mIU/L) = 0.15 (0.3 - 3)
Ca (mg/dL) = 8.8 (8.5 - 10.5)
Albumin (g/dL) = 3.2 (3.5 - 5)
Theophylline peak level (mcg/mL) = 7
Question
Based on LY's lab results, what undiagnosed condition does she have that could present with symptoms of anxiety (e.g., tachycardia, shortness of breath, insomnia)?

Answer
A
Hypocalcemia
B
Hypokalemia
C
Hyperthyroidism
D
Hyperglycemia
E
Hypoalbuminemia

History of Present Illness: LY is a 45 year old female who presents to her PCP on August 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP, but is often resistant to suggestions and advice from healthcare providers.

Allergies: no known drug allergies

Past Medical History: hypertension, osteoarthritis, allergic rhinitis, asthma, and anxiety

Current Medications (obtained from active prescription bottles on 8/1):
Zestril 10 mg daily
Hydrochlorothiazide 12.5 mg daily
ProAir HFA 2 inhalations Q6H PRN (last two refill dates: 7/29, 6/3)
Protonix 40 mg daily
Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop (on day 5 of treatment)
Ibuprofen 400 mg daily
Zyrtec D 1 tablet BID
Pulmicort Flexhaler 1 inhalation BID
Theophylline 300 mg PO daily

Expired Prescriptions and No Refills:
3/15: Xanax 0.5 mg TID x 30 days. No refills
3/15: Zoloft 50 mg daily. Disp #30. No refills.
4/25: Valium 2 mg BID x 5 days. No refills.
6/1: Lyrica 50 mg TID. Disp #90. No refills

Vitals:
Height: 5'6" Weight: 125 pounds
BP: 152/86 mmHg HR: 95 BPM RR: 13 BPM Temp: 98.5°F Pain: 2/10

Physical Exam:
Neuro: alert and oriented
HEENT: few white plaques on the tongue and inner cheeks
CV: RRR
Abdomen: normal bowel sounds
Extremities: no edema noted, good reflexes

Labs:
Na (mEq/L) = 139 (135 - 145)
K (mEq/L) = 3.1 (3.5 - 5)
Cl (mEq/L) = 100 (95 - 103)
HCO3 (mEq/L) = 25 (24 - 30)
BUN (mg/dL) = 12 (7 - 20)
SCr (mg/dL) = 0.8 (0.6 - 1.3)
Glucose (mg/dL) = 147 (100 - 125)
TSH (mIU/L) = 0.15 (0.3 - 3)
Ca (mg/dL) = 8.8 (8.5 - 10.5)
Albumin (g/dL) = 3.2 (3.5 - 5)
Theophylline peak level (mcg/mL) = 7
Question
In reviewing LY's medication history, you find a note from 4/25 that says "Zoloft 50 mg has not improved anxiety, switch to Valium". What is the most likely reason that Zoloft was not effective?

Answer
A
It was used alone, instead of in combination with a benzodiazepine.
B
It was used alone, instead of in combination with buspirone.
C
The duration of use may have been too short, and the dose too low.
D
The patient was most likely not compliant with the medication.
E
It is not a preferred drug for treatment of anxiety.

Which of the following medications would be considered first line in panic disorder?

What is the first line treatment for anxiety?

Which of the following medications is considered a first line treatment for anxiety in children?

Which is the first line treatment option for acute stress or fluctuating anxiety?