Which medication would be considered a first-line medication therapy for generalized anxiety disorder (GAD)?

Paroxetine (Paxil)

Imipramine (Tofranil)

Hydroxyzine (Vistaril)

Alprazolam (Xanax)

Answer and Explanation

The Correct Answer is A

Choice A reason: Paroxetine, an SSRI, is first-line for GAD, enhancing serotonin in the amygdala and prefrontal cortex, reducing excessive worry. Its efficacy and tolerability, with minimal dependence risk, align with evidence-based guidelines for long-term anxiety management, making it the preferred choice.

Choice B reason: Imipramine, a tricyclic antidepressant, affects serotonin and norepinephrine but has significant anticholinergic side effects, reducing tolerability. It is not first-line for GAD due to slower onset and side effect profile compared to SSRIs, which better target anxiety’s neurobiological basis.

Choice C reason: Hydroxyzine, an antihistamine, reduces anxiety via histamine receptor blockade, causing sedation. It is used as needed, not for chronic GAD management. SSRIs, like paroxetine, offer sustained serotonin modulation, making hydroxyzine a less effective, non-first-line option for long-term treatment.

Choice D reason: Alprazolam, a benzodiazepine, enhances GABA activity, providing rapid anxiety relief but carries high dependence risk. It is not first-line for GAD, as SSRIs offer safer, long-term serotonin-based treatment, making alprazolam unsuitable for chronic management due to addiction potential.

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Correct Answer is D

Explanation

Choice A reason: Buspirone enhances serotonin activity, taking weeks to reduce anxiety. Panic attacks, driven by acute norepinephrine surges in the amygdala, require rapid intervention. Buspirone’s delayed onset makes it ineffective for acute symptom relief, unlike fast-acting options targeting immediate neurochemical imbalances.

Choice B reason: Venlafaxine, an SNRI, increases serotonin and norepinephrine over weeks, unsuitable for acute panic attacks. Panic involves rapid sympathetic activation, requiring immediate GABA enhancement or similar fast-acting mechanisms, not gradual reuptake inhibition, making venlafaxine incorrect for rapid relief.

Choice C reason: Imipramine, a tricyclic, modulates serotonin and norepinephrine but takes weeks to act. Acute panic, driven by locus coeruleus norepinephrine spikes, needs immediate relief. Imipramine’s slow onset and side effects make it inappropriate for rapid intervention in acute anxiety episodes.

Choice D reason: Alprazolam, a benzodiazepine, enhances GABA-A receptor activity, rapidly inhibiting excessive neural firing in the amygdala during panic attacks. This provides quick relief from acute anxiety symptoms, like tachycardia, within minutes, making it the correct choice for immediate neurobiological stabilization in panic episodes.

A. Hydroxyzine (Vistaril) B. Imipramine (Tofranil) C. Propranolol (Inderal) D. Buspirone (Buspar)

Correct Answer is C

Explanation

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.

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Which medication would be considered a first-line medication therapy for generalized anxiety disorder (GAD)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is experiencing a panic attack. What medication will provide the quickest relief from acute severe anxiety symptoms?

Correct Answer is D

Explanation

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?

Correct Answer is C

Explanation

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