A 26-year-old man complains of tremors, tachycardia, and diaphoresis when speaking in public. He has started a new job that requires him to give frequent presentations to large audiences and is worried he would not be able to work effectively. His physician prescribes propranolol. How will propranolol help with this patient's anxiety?

Correct Answer: E

Rationale: The correct answer is not provided in the options given. The most appropriate answer in this case should be: E) Propranolol is a beta-blocker that can help alleviate the physical symptoms of anxiety such as tremors, tachycardia, and diaphoresis. By blocking beta-adrenergic receptors, propranolol reduces the effects of adrenaline, which is responsible for these symptoms. This allows the individual to feel more physically calm and in control, which can be beneficial for situations like public speaking where anxiety symptoms can be disruptive. Let's analyze why the other options are incorrect: A) CNS sedation: Propranolol does not exert its anxiolytic effects through CNS sedation. It works peripherally by blocking beta receptors. B) CNS stimulation: This is incorrect as propranolol is not a CNS stimulant. It acts peripherally on beta receptors. C) Patients with anxiety usually have comorbid heart disease: This statement is not universally true and is not directly related to the mechanism of action of propranolol in managing anxiety. D) Propranolol is not used to treat anxiety: This is incorrect as propranolol is commonly used off-label to manage performance anxiety and situational anxiety by alleviating physical symptoms. Educational context: It is important for healthcare professionals to understand the pharmacological mechanisms of drugs used in the treatment of anxiety disorders. Propranolol's role in managing performance anxiety can be a valuable addition to the treatment options available, especially for individuals who primarily experience physical symptoms of anxiety. Understanding how medications work can help clinicians make informed decisions when selecting appropriate treatments for patients.

Correct Answer: A

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: D

Rationale: The correct answer is D) Lorazepam. In this scenario, the patient is likely experiencing cocaine withdrawal symptoms, such as agitation, anxiety, and insomnia. Lorazepam, a benzodiazepine, is commonly used to manage these symptoms by providing sedation and calming effects on the central nervous system. It helps alleviate the hyperarousal and agitation associated with cocaine withdrawal. Option A) Cocaine would not be used to counter cocaine withdrawal symptoms as it would exacerbate the issue by further stimulating the central nervous system. Option B) Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used primarily for depression and anxiety disorders, not acute cocaine withdrawal symptoms. Option C) Hydroxyzine is an antihistamine with sedative properties, but it is not the first-line treatment for cocaine withdrawal symptoms, especially when rapid sedation is required. Educationally, this question highlights the importance of recognizing and managing acute drug withdrawal symptoms effectively in emergency settings. Understanding the pharmacological principles behind drug actions and withdrawal symptoms is crucial for healthcare providers to provide safe and appropriate care to patients with substance use disorders.

Correct Answer: A

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: C

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.