Chapter 12 Anxiety Disorders Q&A (1 of 44) Sample Questions

1. MP, a 68-year-old man and a veteran, presented in a clinic with complaints of insomnia, nightmare, intense fear and feeling of helplessness following his return from the war. MP has no other medical conditions and not on any medication besides acetaminophen 500 mg prn. Physical examination does not indicate any metabolic abnormality or heart problems. MP does not have history of substance abuse. CBC all within normal range, GGT result does not indicate alcohol abuse. TT3: 220 ng/dL(80-180 ng/dL); FT3: 7 pmol/L (3.7–6.5 pmol/L) TT4: 13 ug/dL(4.5-12.5 ug/dL); BP: 140/110; HR: 130. An elevation of TT3/FT4 ratio is also noted. His doctor diagnosed his condition as Post Traumatic Stress Disorder. What is the first line therapy?
  1. A. Trazodone
  2. B. Fluoxetine
  3. C. Bupropion
  4. D. Mirtazapine
Answer
Ans: B
Tips: RxTx/CTC 2019. PTSD Chapter. SSRIs and SNRIs have been shown to reduce the severity of all the symptom clusters of PTSD. Fluoxetine, paroxetine, sertraline and venlafaxine are first-line options.
Trazodone is used in insomnia management when nonpharmacologic measures failed.
Mirtazapine and other antidepressants like fluvoxamine, moclobemide and phenelzine are second-line agents.