Nervous Man Questions
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Jeremy Jones is 35 years old. He has always been a nervous, anxious, and quite insecure person. In spite of this, he has done well in his job, and he recently was promoted to office supervisor. He has a history of panic disorder, and he has been on an SSRI, which seems to take care of the symptoms pretty well. He has not had any panic attacks in quite some time, but in the last few weeks, he has noticed a marked increase in anxiety, including some "close calls" as far as having another panic attack. Jeremy's roomate, Joan, has a long-standing fear of flying. She wanted to attend a family reunion in California last year. Her primary care doctor gave her a prescription for Xanax (alprazolam) to help her make it through the plane trip. Joan had a number of pills left over, and she offered them to Jeremy for anxiety relief. Reluctantly, Jeremy took her up on the offer. Lo and behold, he felt significant symptom relief, with no adverse side effects. He started to take the remaining Xanax pills on a fairly regular basis. Jeremy rarely drinks alcohol and he does not use illicit drugs. Today, Jeremy is in your office requesting a prescription for Xanax (alprazolam) for himself. What is this all about? 1. Is Jeremy a substance abuser, trying to get benzos from you? He doesn’t seem like a substance abuser, but he shouldn’t use other people’s prescriptions. 2. What medications are appropriate for panic disorder? SSRI, such as paroxetine, sertraline, citalopram, and escitalopram. 3. Would you use the same dosage of SSRI as you would for depression? You start with a lower dose than you would for 4. What about that Xanax (alprazolam): is it helpful in panic disorder? 5. Please list special categories of patients in whom you should be cautious about prescribing benzodiazepines? 6. Describe the underlying mechanism of tolerance to benzodiazepines. 7. What is the big problem with short-acting benzodiazepines? Why is it a problem (what is the physiological mechanism that accounts for the problem)? Is there a place for drugs that have a short half-life? 8. Which of the benzodiazepines are long acting? Why might they be preferable in the treatment of anxiety?
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Transcript of Nervous Man Questions
Jeremy Jones is 35 years old. He has always been a nervous, anxious, and quite insecure person. In spite of this, he has done well in his job, and he recently was promoted to office supervisor. He has a history of panic disorder, and he has been on an SSRI, which seems to take care of the symptoms pretty well. He has not had any panic attacks in quite some time, but in the last few weeks, he has noticed a marked increase in anxiety, including some "close calls" as far as having another panic attack.
Jeremy's roomate, Joan, has a long-standing fear of flying. She wanted to attend a family reunion in California last year. Her primary care doctor gave her a prescription for Xanax (alprazolam) to help her make it through the plane trip. Joan had a number of pills left over, and she offered them to Jeremy for anxiety relief. Reluctantly, Jeremy took her up on the offer. Lo and behold, he felt significant symptom relief, with no adverse side effects. He started to take the remaining Xanax pills on a fairly regular basis. Jeremy rarely drinks alcohol and he does not use illicit drugs.
Today, Jeremy is in your office requesting a prescription for Xanax (alprazolam) for himself. What is this all about?1. Is Jeremy a substance abuser, trying to get benzos from you?He doesnt seem like a substance abuser, but he shouldnt use other peoples prescriptions.2. What medications are appropriate for panic disorder?
SSRI, such as paroxetine, sertraline, citalopram, and escitalopram. 3. Would you use the same dosage of SSRI as you would for depression?
You start with a lower dose than you would for 4. What about that Xanax (alprazolam): is it helpful in panic disorder? 5. Please list special categories of patients in whom you should be cautious about prescribing benzodiazepines?6. Describe the underlying mechanism of tolerance to benzodiazepines. 7. What is the big problem with short-acting benzodiazepines? Why is it a problem (what is the physiological mechanism that accounts for the problem)? Is there a place for drugs that have a short half-life?8. Which of the benzodiazepines are long acting? Why might they be preferable in the treatment of anxiety? 9. Benzodiazepines are addictive. How can you justify using an addictive medication? What do you need to be aware of in the patient's history, and what precautions do you need to take? Medico-legally, what kind of issues arise?10. What types of therapy may be helpful in treatment of panic disorder?
