A woman brings in her son to your office saying that he is an alcoholic who denies it.
Among the questions you could ask him, what question is least relevant?
Correct Answer C:
The C.A.G.E. questionnaire is an important tool in evaluating potential alcoholics. The questions are as follows:
C: Have you ever tried to Cut down on drinking?
A: Have you ever felt Annoyed at criticism of your drinking?
G: Have you ever felt Guilty about your drinking?
E: Have you ever needed a drink first thing in morning? ‘Eye opener”
The best way to prevent benzodiazepine dependence is:
Correct Answer B:
Benzodiazepines have addictive properties. If a benzo with shorter half-life is used, there is more dependency since the patient will see the effect of the drug wear off faster. The better option is to counsel against long term use of such medicines.
When prescribing benzodiazepines the following guidelines should be used:
You are treating a 34-year-old white male for anxiety, panic disorder, and a history of alcoholism. He has been abstinent from alcohol for 6 years.
Which one of the following treatment options carries the greatest risk of physical dependence?
Correct Answer A:
Alprazolam (choice A) is a benzodiazepine. It is capable of producing physical dependence, and the risk is substantially elevated in a patient with a history of alcohol dependence.
→ Imipramine (choice B) is a tricyclic drug and does not carry a risk of physical addiction or dependence.
→ Buspirone (choice C) is in the azapirone class. It does not produce sedation or euphoria. There is no withdrawal syndrome or dependence.
→ Propranolol (choice D) is a beta-blocker and may be useful for controlling somatic symptoms of anxiety. While Beta-blockers are not addictive, abrupt withdrawal may be hazardous due to potential cardiovascular side effects.
→ Phenelzine (choice E) is an MAO inhibitor. Physical dependence is not a problem with this drug class.
Which one of the following benzodiazepines has the shortest half-life?
Alprazolam (Xanax) has a half-life of about 12 hours, versus 25 hours for clonazepam and nitrazepam and 50 hours for clorazepate, and diazepam.
A 43-year-old female presents to the Emergency Department with severe anxiety. She reports that she had been taking alprazolam up to four times a day for panic attacks. Over the past few days, her anxiety symptoms are worse and she complains of trouble falling asleep and nausea. On further evaluation, she admits that "for the past several weeks or so" she has been skipping her regular doses because a friend told her that the medication she is taking is addicting.
Which of the following would be the most appropriate intervention?
Correct Answer D:
Discontinuation of benzodiazepines, such as alprazolam, can lead to relapse or rebound symptoms of anxiety, or more severe withdrawal symptoms. Rebound symptoms such as anxiety, insomnia, and GI symptoms are milder and short lived. However, symptoms of withdrawal are more serious, such as agitation, tachycardia, palpitations, blurred vision, muscle cramps, and seizures. In an emergency setting, educating the patient about risks associated with discontinuation of benzodiazepines would be most appropriate and prevent more serious effects.
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