Alright, here is a question that I'd like to call physician heal
thyself and then get back to work. So here is a 45 year old
emergency physician is complaining of anxiety, difficulty
sleeping and an inability to deal with the stresses of work.
Buspirone is prescribed. The following are true about this
medication. A, the patient may not notice improvement for 10 days.
B, buspirone has a high addictive potential and should not
be given to a person with ready access to medications.
Is it C, buspirone acts through antagonizing orexin receptors
in the brain? Or D, it may cause sedation and motor coordination
problems and it should not be used in this patient? Which one
is correct? Right, A. This is the downside of this particular agent
but otherwise it has a lot of advantages. In a person who
requires on their motor skills you really want to give this drug.
It does not really have a high addictive potential which is
another advantage. And in terms of how it acts, it does not
act through the orexin receptors, so C is incorrect. Let's
take a look at a 21 year old grocery clerk who complains of
occasional rapid heart rate, sweating, anxiety and nausea. Now
what brings this symptoms on. It's brought about when her
supervisor is present. She doesn't complain of any symptoms
when she is on holidays or away from work. The best medication
to use in this situation is propranolol, eszopiclone, zopiclone,
tasimelteon or alprazolam? Okay so let's take a look at our
choices here. The correct answer is alprazolam. Let's see why
the other ones are not correct. A, propranolol. Propranolol is a
beta blocker, a very old drug and it was one of the first drugs
used in anxiety treatment. Propranolol blocks the adrenaline
response of anxiety and so it masks some of the symptoms.
Propranolol is used in very rare situations like stage fright
where people still need to be highly alert on their game,
but the symptoms only occurs when they are speaking. So propranolol
can be a choice but it's not the best choice. Eszopiclone and
zopiclone are great agents for generalized anxiety disorder
and they are great agents for insomnia but they are not
particularly good agents for acute anxiety states brought about by
situations or what we call panic attacks. Tasimelteon is a
fantastic drug for managing sleep disorder and it's a great
drug for insomnia, not so much for generalized or acute
anxiety. The correct answer is alprazolam, a short acting
benzodiazepine. It works well, it calms the limbic system
and it would be the drug of choice in this situation.
Well there you have it. If you have any concerns or
questions, just email us. And good luck on your exams.