A patient reports experiencing performance anxiety in front of an audience. The nurse should be aware that this type of anxiety is often treated with which medication?

Choice A reason: Hydroxyzine, an antihistamine, reduces anxiety via sedation but is not specific for performance anxiety. It blocks histamine receptors, not sympathetic responses like tachycardia in stage fright. Propranolol better targets physical symptoms, making hydroxyzine less effective for this specific anxiety type.

Choice B reason: Imipramine, a tricyclic, treats generalized anxiety or depression via serotonin-norepinephrine reuptake inhibition but is not ideal for performance anxiety. Its slow onset and side effects make it unsuitable for acute, situational sympathetic activation, unlike propranolol’s rapid effect on physical symptoms.

Choice C reason: Propranolol, a beta-blocker, reduces sympathetic symptoms like tachycardia and trembling in performance anxiety by blocking norepinephrine at beta receptors. This calms physical manifestations of amygdala-driven fear, making it the preferred choice for situational anxiety, aligning with evidence-based treatment for performance anxiety.

Choice D reason: Buspirone enhances serotonin for chronic anxiety but takes weeks to act, unsuitable for acute performance anxiety. Sympathetic activation in stage fright requires rapid beta-blockade, not gradual serotonin modulation, making buspirone incorrect for the immediate needs of this condition.

Choice A reason: Histamine blockade, as in antipsychotics like olanzapine, promotes sedation, not weight loss. Weight gain is common due to histamine’s role in appetite regulation via hypothalamic signaling. Weight loss is not a typical side effect, making this response inaccurate for histamine-blocking medications.

Choice B reason: Histamine receptor blockade, common in medications like quetiapine, reduces wakefulness by inhibiting histamine’s alerting effects in the cortex. This causes drowsiness, a frequent side effect in psychiatric treatments, aligning with the pharmacological mechanism and making this the correct response.

Choice C reason: Insomnia is not typical with histamine blockade, which promotes sedation. Histamine enhances alertness; blocking it, as in antihistaminic antipsychotics, induces sleepiness, not wakefulness. This response contradicts the neuropharmacological effect, making it incorrect for expected side effects.

Choice D reason: Blood pressure increase is unrelated to histamine blockade. Histamine affects wakefulness and appetite, not vascular tone directly. Antihistaminic drugs may cause orthostatic hypotension via other receptors, not hypertension, making this response inaccurate for histamine-blocking medication effects.