MCQ Quiz: Management of Anxiety Disorders

Effective management of anxiety disorders is a core competency for pharmacists, requiring a deep understanding of pharmacotherapy, patient counseling, and non-pharmacological strategies. The Patient Care VII: Brain and Behavior curriculum provides a comprehensive framework for managing conditions such as Generalized Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, PTSD, and OCD. This quiz will test your knowledge on first-line treatments, the appropriate role of benzodiazepines, specific strategies for complex disorders like OCD and PTSD, and key communication techniques essential for optimal patient care.

1. Which two classes of medications are considered first-line for the long-term management of Generalized Anxiety Disorder (GAD), Panic Disorder, and Social Anxiety Disorder?

• A. Benzodiazepines and Barbiturates
• B. SSRIs and SNRIs
• C. Typical Antipsychotics and MAOIs
• D. Beta-blockers and Antihistamines

Answer: B. SSRIs and SNRIs

2. When initiating an SSRI for an anxiety disorder, why is a “start low, go slow” titration strategy often employed?

• A. To minimize the risk of initial activating side effects like jitteriness or increased anxiety.
• B. To prevent drug-food interactions.
• C. To ensure the drug reaches its peak concentration within the first day.
• D. To decrease the cost of the medication.

Answer: A. To minimize the risk of initial activating side effects like jitteriness or increased anxiety.

3. What is the appropriate role for benzodiazepines in the management of GAD?

• A. As first-line, long-term monotherapy.
• B. As a short-term adjunctive therapy while waiting for a first-line agent like an SSRI to take effect.
• C. They are not recommended for any form of anxiety.
• D. As a primary treatment for comorbid depression.

Answer: B. As a short-term adjunctive therapy while waiting for a first-line agent like an SSRI to take effect.

4. The management of Obsessive-Compulsive Disorder (OCD) often requires what adjustment to SSRI therapy compared to its use in depression?

• A. Lower doses are typically used.
• B. The medication is dosed only once a week.
• C. Higher doses and a longer duration trial are often necessary to see an effect.
• D. A rapid titration is preferred.

Answer: C. Higher doses and a longer duration trial are often necessary to see an effect.

5. Prazosin is an alpha-1 adrenergic antagonist used as an adjunctive agent in Post-Traumatic Stress Disorder (PTSD) to target which specific symptom?

• A. Depressive mood
• B. Anhedonia
• C. Avoidance
• D. Nightmares and sleep disturbances.

Answer: D. Nightmares and sleep disturbances.

6. Buspirone is an FDA-approved treatment for GAD. A key counseling point regarding its onset of action is that it:

• A. Provides immediate anxiety relief within minutes.
• B. May take 2 to 4 weeks to exert its full anxiolytic effect.
• C. Works best when taken on an “as-needed” basis.
• D. Is a controlled substance with high abuse potential.

Answer: B. May take 2 to 4 weeks to exert its full anxiolytic effect.

7. Which medication class is generally NOT recommended for the management of PTSD due to a lack of efficacy and potential to worsen recovery?

• A. SSRIs
• B. SNRIs
• C. Benzodiazepines
• D. Atypical Antipsychotics

Answer: C. Benzodiazepines

8. Hydroxyzine is an antihistamine that can be used for anxiety. Its anxiolytic effect is primarily due to:

• A. Serotonin 5-HT1A partial agonism.
• B. Potentiation of GABA.
• C. Its sedating properties from H1 receptor blockade.
• D. Dopamine reuptake inhibition.

Answer: C. Its sedating properties from H1 receptor blockade.

9. A patient with performance anxiety (a type of social anxiety disorder) has to give a speech. Which medication can be taken on an as-needed basis to control peripheral autonomic symptoms like tremor and tachycardia?

• A. Sertraline
• B. Propranolol
• C. Buspirone
• D. Lorazepam

Answer: B. Propranolol

10. What is a crucial non-pharmacological treatment that is considered first-line for most anxiety disorders and is often combined with medication?

• A. A high-caffeine diet.
• B. Social isolation.
• C. Cognitive Behavioral Therapy (CBT).
• D. Avoiding all physical activity.

Answer: C. Cognitive Behavioral Therapy (CBT).

11. A patient taking a benzodiazepine for panic attacks should be counseled on the risk of what when combining it with alcohol?

• A. Additive CNS and respiratory depression.
• B. A hypertensive crisis.
• C. Decreased efficacy of the benzodiazepine.
• D. A severe skin rash.

Answer: A. Additive CNS and respiratory depression.

12. The management of anxiety disorders is a specific topic covered in which Patient Care course module?

• A. Module 4: Mood Disorders
• B. Module 5: Anxiety and Sleep-Wake Disorders
• C. Module 6: Epilepsy
• D. Module 7: Other Neuropsychiatric Disorders

Answer: B. Module 5: Anxiety and Sleep-Wake Disorders

13. A patient who has been taking clonazepam 1mg daily for a year should be advised to taper the dose upon discontinuation to avoid:

• A. Severe weight gain.
• B. Anticholinergic rebound.
• C. Withdrawal symptoms, including rebound anxiety and potential seizures.
• D. Liver toxicity.

Answer: C. Withdrawal symptoms, including rebound anxiety and potential seizures.

14. Which tricyclic antidepressant (TCA) is highly effective for OCD but is considered second-line due to its side effect profile?

• A. Nortriptyline
• B. Desipramine
• C. Clomipramine
• D. Doxepin

Answer: C. Clomipramine

15. A key principle in the management of anxiety disorders with SSRIs/SNRIs is:

• A. Starting with the maximum possible dose.
• B. Ensuring an adequate trial duration of at least 4-6 weeks at a therapeutic dose.
• C. Discontinuing the medication as soon as symptoms improve slightly.
• D. Using them for short-term treatment only.

Answer: B. Ensuring an adequate trial duration of at least 4-6 weeks at a therapeutic dose.

16. Which herbal supplement has been studied for anxiety but is associated with a significant risk of severe hepatotoxicity?

• A. Melatonin
• B. St. John’s Wort
• C. Kava
• D. Valerian

Answer: C. Kava

17. If a patient with GAD fails an adequate trial of an SSRI, a reasonable next step would be to:

• A. Switch to another SSRI or an SNRI.
• B. Immediately start an MAOI.
• C. Discontinue all medications and recommend psychotherapy only.
• D. Add a high-dose stimulant.

Answer: A. Switch to another SSRI or an SNRI.

18. The “Assess” step of the Pharmacists’ Patient Care Process for a patient with anxiety would involve:

• A. Only verifying their insurance information.
• B. Evaluating the patient’s symptoms, medication history, and lifestyle to formulate a problem list.
• C. Handing the patient their prescription bag.
• D. Immediately recommending an OTC product.

Answer: B. Evaluating the patient’s symptoms, medication history, and lifestyle to formulate a problem list.

19. What is the primary advantage of buspirone over benzodiazepines in the long-term management of GAD?

• A. It has a much faster onset of action.
• B. It lacks the potential for physical dependence and abuse.
• C. It is also a potent hypnotic.
• D. It does not have any drug interactions.

Answer: B. It lacks the potential for physical dependence and abuse.

20. The first-line medications for Panic Disorder work by:

• A. Only treating the panic attack once it starts.
• B. Reducing the frequency and intensity of future panic attacks over time.
• C. Causing sedation so the patient is unaware of the attack.
• D. Increasing blood pressure to counteract panic symptoms.

Answer: B. Reducing the frequency and intensity of future panic attacks over time.

21. A patient with social anxiety disorder fears situations where they might be judged or scrutinized. This is the primary target of:

• A. Pharmacotherapy with SSRIs.
• B. Psychotherapy like CBT.
• C. Beta-blockers for performance situations.
• D. All of the above.

Answer: D. All of the above.

22. Which of the following benzodiazepines has a long half-life, making it less ideal for PRN use but potentially useful for a taper?

• A. Alprazolam
• B. Lorazepam
• C. Diazepam
• D. Midazolam

Answer: C. Diazepam

23. Augmentation with a second-generation antipsychotic may be considered in the management of:

• A. Mild GAD.
• B. Treatment-resistant OCD or PTSD.
• C. Performance anxiety.
• D. A patient who cannot tolerate an SSRI.

Answer: B. Treatment-resistant OCD or PTSD.

24. The main goal in managing panic disorder is to help the patient learn that panic attacks, while terrifying, are not:

• A. A real experience.
• B. Treatable.
• C. Life-threatening (e.g., they are not a heart attack).
• D. A sign of a serious illness.

Answer: C. Life-threatening (e.g., they are not a heart attack).

25. A pharmacist counseling a patient starting an SNRI like venlafaxine for social anxiety disorder should mention which potential side effect to monitor?

• A. Weight loss
• B. An increase in blood pressure.
• C. Sedation
• D. Metallic taste

Answer: B. An increase in blood pressure.

26. The most effective management strategy for most anxiety disorders is:

• A. Medication only.
• B. Psychotherapy only.
• C. A combination of evidence-based pharmacotherapy and psychotherapy.
• D. Herbal supplements only.

Answer: C. A combination of evidence-based pharmacotherapy and psychotherapy.

27. What is a key reason for the delayed onset of action of SSRIs in anxiety?

• A. The drugs are poorly absorbed.
• B. The therapeutic effect requires neuroadaptive changes, such as receptor downregulation, which takes time.
• C. The drugs must first be converted to active metabolites.
• D. The drugs have a very long half-life.

Answer: B. The therapeutic effect requires neuroadaptive changes, such as receptor downregulation, which takes time.

28. “Rebound anxiety” is a common symptom of:

• A. Starting an SSRI.
• B. Abruptly discontinuing a benzodiazepine.
• C. Taking buspirone as scheduled.
• D. Long-term treatment with an SNRI.

Answer: B. Abruptly discontinuing a benzodiazepine.

29. In the management of GAD, benzodiazepines are best used:

• A. On a daily, scheduled basis for at least one year.
• B. As a “bridge” for 2-4 weeks while an SSRI takes effect.
• C. As first-line monotherapy.
• D. In combination with an MAOI.

Answer: B. As a “bridge” for 2-4 weeks while an SSRI takes effect.

30. The “Implementation” step of the PPCP for an anxious patient includes:

• A. Assessing their symptoms.
• B. Creating the care plan.
• C. Educating the patient on their medication, including its purpose, side effects, and proper use.
• D. Following up on their progress.

Answer: C. Educating the patient on their medication, including its purpose, side effects, and proper use.

31. Which of the following would be an inappropriate first-line recommendation for a patient with newly diagnosed Panic Disorder?

• A. Sertraline
• B. Venlafaxine XR
• C. Alprazolam as needed
• D. Cognitive Behavioral Therapy

Answer: C. Alprazolam as needed

32. The “compulsions” in OCD are:

• A. Recurrent, intrusive thoughts or urges.
• B. Repetitive behaviors or mental acts performed to reduce the anxiety caused by obsessions.
• C. Physical symptoms of anxiety.
• D. A state of elevated mood.

Answer: B. Repetitive behaviors or mental acts performed to reduce the anxiety caused by obsessions.

33. The long-term management goal for a patient with Social Anxiety Disorder is to:

• A. Enable them to avoid all social situations.
• B. Reduce the fear and avoidance associated with social situations, allowing for improved functioning.
• C. Treat their symptoms with benzodiazepines indefinitely.
• D. Eliminate the need for any social interaction.

Answer: B. Reduce the fear and avoidance associated with social situations, allowing for improved functioning.

34. A patient is prescribed buspirone. They should be counseled to avoid large amounts of:

• A. Leafy green vegetables.
• B. Dairy products.
• C. Tyramine-rich foods.
• D. Grapefruit juice, as it can inhibit CYP3A4 and increase buspirone levels.

Answer: D. Grapefruit juice, as it can inhibit CYP3A4 and increase buspirone levels.

35. A key difference in managing anxiety versus depression is the initial titration of SSRIs. For anxiety, the starting dose is often:

• A. Higher than the starting dose for depression.
• B. The same as the starting dose for depression.
• C. Lower than the starting dose for depression, to improve tolerability.
• D. A loading dose.

Answer: C. Lower than the starting dose for depression, to improve tolerability.

36. Which of the following is an example of a “compulsion” in OCD?

• A. A recurring thought that one’s hands are contaminated.
• B. A persistent fear of social embarrassment.
• C. Repeatedly washing one’s hands to the point of causing skin damage.
• D. A sudden feeling of intense fear.

Answer: C. Repeatedly washing one’s hands to the point of causing skin damage.

37. The “Follow-up: Monitor and Evaluate” step of the PPCP for an anxiety patient on a new SNRI would include assessing:

• A. Adherence to the medication.
• B. Reduction in anxiety symptoms.
• C. Presence of adverse effects like nausea or increased blood pressure.
• D. All of the above.

Answer: D. All of the above.

38. The use of benzodiazepines like lorazepam is appropriate in which of these scenarios?

• A. Long-term daily use for GAD.
• B. As-needed use for a patient with a fear of flying who flies twice a year.
• C. First-line treatment for PTSD.
• D. Monotherapy for OCD.

Answer: B. As-needed use for a patient with a fear of flying who flies twice a year.

39. A patient with GAD reports that buspirone was not effective after taking it “as needed” for two weeks. The pharmacist should explain that:

• A. The drug is not effective for GAD.
• B. The drug must be taken on a scheduled daily basis to work, and it has a delayed onset of action.
• C. They should have taken a higher dose.
• D. They are likely resistant to all anxiety medications.

Answer: B. The drug must be taken on a scheduled daily basis to work, and it has a delayed onset of action.

40. Why is it important to screen for substance use disorders when managing a patient’s anxiety?

• A. It is not important as the conditions are unrelated.
• B. The two conditions are highly comorbid, and substance use can mimic or worsen anxiety symptoms.
• C. All anxiety patients abuse substances.
• D. It dictates which pharmacy they are allowed to use.

Answer: B. The two conditions are highly comorbid, and substance use can mimic or worsen anxiety symptoms.

41. The primary therapeutic goal in managing panic disorder is to eliminate:

• A. All sources of stress from the patient’s life.
• B. The patient’s need for social interaction.
• C. The panic attacks and the anticipatory anxiety about having them.
• D. The patient’s response to psychotherapy.

Answer: C. The panic attacks and the anticipatory anxiety about having them.

42. A patient with OCD fails trials of two different SSRIs. What is a potential next pharmacological step?

• A. Trying a third SSRI.
• B. Switching to the TCA clomipramine.
• C. Augmenting the SSRI with a second-generation antipsychotic.
• D. Both B and C are reasonable options.

Answer: D. Both B and C are reasonable options.

43. A pharmacist providing an in-service presentation on anxiety management to other healthcare professionals is an example of which Entrustable Professional Activity (EPA)?

• A. Fulfilling a medication order.
• B. Delivering medication or health-related education to health professionals or the public.
• C. Identifying populations at risk for prevalent diseases.
• D. Creating a care plan.

Answer: B. Delivering medication or health-related education to health professionals or the public.

44. Which of the following is a key feature of GAD?

• A. Recurrent, unexpected panic attacks.
• B. Excessive, uncontrollable worry about numerous events or activities.
• C. A persistent fear of social situations.
• D. The presence of intrusive obsessions.

Answer: B. Excessive, uncontrollable worry about numerous events or activities.

45. Which of the following is a symptom of a panic attack?

• A. Gradual onset of mild worry.
• B. A discrete period of intense fear accompanied by physical symptoms like palpitations, sweating, and shortness of breath.
• C. A persistent low mood.
• D. A feeling of social ease.

Answer: B. A discrete period of intense fear accompanied by physical symptoms like palpitations, sweating, and shortness of breath.

46. The management plan for a patient with anxiety should be:

• A. The same for every patient.
• B. Decided solely by the pharmacist.
• C. An individualized, patient-centered care plan created in collaboration with the patient and other healthcare professionals.
• D. Focused only on medication and not on lifestyle or therapy.

Answer: C. An individualized, patient-centered care plan created in collaboration with the patient and other healthcare professionals.

47. When counseling a patient on a new benzodiazepine, it’s crucial to mention the risk of:

• A. Increased energy and alertness.
• B. Sedation and impaired motor coordination, advising against driving until they know how the drug affects them.
• C. Hypertension.
• D. Weight loss.

Answer: B. Sedation and impaired motor coordination, advising against driving until they know how the drug affects them.

48. What is the role of the pharmacist when a patient with anxiety wants to use an herbal product like kava?

• A. To encourage its use as a safe alternative.
• B. To educate the patient on the lack of regulation and the serious risk of liver damage associated with kava.
• C. To sell them the most expensive brand.
• D. To state that it has no effect.

Answer: B. To educate the patient on the lack of regulation and the serious risk of liver damage associated with kava.

49. A patient with Social Anxiety Disorder is prescribed sertraline. They should be counseled that:

• A. The medication will work immediately and should only be taken before social events.
• B. The medication must be taken daily and may take several weeks to become effective for social anxiety symptoms.
• C. This medication is not approved for social anxiety.
• D. The primary side effect is weight loss.

Answer: B. The medication must be taken daily and may take several weeks to become effective for social anxiety symptoms.

50. The comprehensive management of anxiety disorders requires an interprofessional team approach. The pharmacist’s unique expertise is in:

• A. Psychoanalysis.
• B. Surgical interventions.
• C. Optimizing pharmacologic and nonpharmacologic treatment.
• D. Diagnosing the specific anxiety disorder.

Answer: C. Optimizing pharmacologic and nonpharmacologic treatment.