Examkin

Soru

Zorluk: KolayAnxiety, OCD, and Trauma-Related Disorders

A 42-year-old man presents to the clinic reporting persistent, overwhelming anxiety. For the past 8 months, he has worried excessively about his job security, finances, and family health. He describes feeling constantly 'on edge,' tires easily, and has severe muscle tension in his neck and shoulders. His medical history is significant for treatment-resistant major depressive disorder, for which he has been taking the monoamine oxidase inhibitor (MAOI) tranylcypromine for the past year with excellent symptom control. Vital signs are within normal limits. The physician diagnoses generalized anxiety disorder (GAD) and discusses pharmacological treatment options. Which of the following medications can be safely initiated for his GAD without precipitating a life-threatening drug-drug interaction? (Select all that apply)

  1. A
    Escitalopram
  2. ClonazepamCevap
  3. C
    Venlafaxine
  4. HydroxyzineCevap
  5. E
    Buspirone

Cevap

Clonazepam and Hydroxyzine
The correct options are clonazepam and hydroxyzine. When treating anxiety in a patient currently taking a monoamine oxidase inhibitor (MAOI) like tranylcypromine, it is critical to avoid any agents that increase serotonergic or noradrenergic transmission. Clonazepam is a benzodiazepine that acts via GABA-A receptor modulation, and hydroxyzine is a histamine H1 receptor antagonist. Neither medication significantly increases serotonin levels, making them safe to co-administer with an MAOI without risking serotonin syndrome or a hypertensive crisis.

Adım Adım Çözüm

1
Identify the patient's current psychiatric medication.
The patient is taking tranylcypromine, which is a monoamine oxidase inhibitor (MAOI).
Knowing the current medication is essential to screen for potential drug-drug interactions when starting a new therapy.
2
Recall the absolute contraindications for patients taking MAOIs.
MAOIs cannot be co-administered with serotonergic agents (SSRIs, SNRIs, TCAs, buspirone) due to the risk of serotonin syndrome or hypertensive crisis.
This pathophysiological rule helps eliminate unsafe pharmacological options.
3
Evaluate the safety of the given options based on their mechanism of action.
Escitalopram, venlafaxine, and buspirone interact dangerously with MAOIs. Clonazepam (a GABA-A modulator) and hydroxyzine (a histamine H1 antagonist) lack serotonergic activity and are safe.
To arrive at the final correct set of safe medications for this patient.

Anahtar Kavram

Pharmacological management of anxiety in patients taking MAOIs requires strictly avoiding serotonergic agents to prevent serotonin syndrome.
Bu soruyu puanla

Konular

Anxiety, OCD, and Trauma-Related Disorders

Bu konudan daha fazla soru