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: Rationale: The correct answer is E) Propranolol is a non-selective beta-adrenergic receptor blocker that helps alleviate the physical symptoms of anxiety, such as tremors, tachycardia, and diaphoresis, by blocking the effects of norepinephrine on beta receptors. In this case, the patient's symptoms are likely due to performance anxiety related to public speaking, a situation that triggers the body's fight-or-flight response. By blocking the beta receptors, propranolol can reduce the physiological manifestations of anxiety without causing CNS sedation or stimulation. Option A) CNS sedation is incorrect because propranolol does not directly act on the central nervous system to produce sedation. Option B) CNS stimulation is also incorrect as propranolol's mechanism of action does not involve CNS stimulation. Option C) Patients with anxiety usually have comorbid heart disease is incorrect as anxiety disorders do not necessarily co-occur with heart disease in all cases. Option D) Propranolol is not used to treat anxiety is incorrect as propranolol is commonly prescribed off-label for performance anxiety and situational anxiety. Educationally, understanding the pharmacological mechanisms of propranolol in managing anxiety can help healthcare professionals make informed decisions when treating patients with similar symptoms. It is crucial to differentiate between the various classes of medications used to manage anxiety and their respective mechanisms of action to provide effective care tailored to individual patient needs.

Correct Answer: A

Rationale: In the context of CNS drugs pharmacology, understanding the changes that occur at the neurotransmitter/synaptic space when an excitatory postsynaptic potential (EPSP) is generated is crucial for comprehending the mechanisms of action of various medications. The correct answer is A) Increased stimulation of excitatory neurons promoting further neurotransmitter release. When an EPSP is generated, it means that the postsynaptic neuron is being depolarized, making it more likely to fire an action potential. This depolarization leads to increased stimulation of excitatory neurons, which in turn promotes further neurotransmitter release. This process amplifies the signal being transmitted across the synapse. Option B and C are incorrect because they mention the release of specific amino acids (alanine and aspartic acid) rather than neurotransmitters. Neurotransmitters are the chemical messengers that transmit signals across the synapse, not amino acids. Option D, repolarization, is also incorrect as it refers to the phase of an action potential when the cell membrane potential is being restored to its resting state after depolarization. Repolarization is a separate process from the changes occurring at the synaptic space during the generation of an EPSP. Educationally, understanding the intricacies of neurotransmission and synaptic potentials is fundamental in comprehending how CNS drugs modulate neural signaling. It allows healthcare professionals to predict the effects of different drugs on neurotransmitter release and synaptic transmission, aiding in the rational selection of pharmacological interventions for various neurological conditions.

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 restlessness. Lorazepam, a benzodiazepine, is commonly used to manage these symptoms by reducing central nervous system excitability. It acts as a sedative and helps counteract the stimulant effects of cocaine withdrawal. Option A) Cocaine would exacerbate the patient's symptoms as it is the substance causing the withdrawal. Option B) Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used for depression and not typically indicated for acute cocaine withdrawal. Option C) Hydroxyzine is an antihistamine with sedative properties, but it is not the first-line treatment for cocaine withdrawal. In an educational context, understanding the pharmacological management of drug withdrawal is crucial for healthcare providers. Benzodiazepines like lorazepam are commonly used to manage acute symptoms of cocaine withdrawal due to their sedative effects and ability to reduce central nervous system hyperactivity. Recognizing the appropriate medication for withdrawal symptoms is essential for providing effective and safe care to patients with substance use disorders.

Correct Answer: A

Rationale: In this scenario, the correct answer is option A) Amitriptyline, which should be avoided in a patient with narrow-angle glaucoma. Amitriptyline is a tricyclic antidepressant that can cause pupillary dilation and precipitate acute angle-closure glaucoma in patients predisposed to this condition. This medication can increase intraocular pressure, which is contraindicated in individuals with narrow-angle glaucoma due to the risk of exacerbating this condition and causing serious complications. Option B) Bupropion is a reasonable choice in this case as it is not known to affect intraocular pressure and is not contraindicated in patients with narrow-angle glaucoma. Option C) Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) which is generally safe for use in patients with narrow-angle glaucoma and can be considered as a treatment option. Option D) Mirtazapine is a noradrenergic and specific serotonergic antidepressant (NaSSA) that does not significantly impact intraocular pressure and can be used in patients with narrow-angle glaucoma without major concerns. Educationally, this question highlights the importance of considering comorbidities and contraindications when prescribing medications, especially in vulnerable patient populations. Understanding the potential side effects and interactions of CNS drugs is crucial for safe and effective pharmacological management.

Correct Answer: C

Rationale: Tapentadol is a centrally acting analgesic that works by binding to opioid receptors and inhibiting the reuptake of norepinephrine. The patient who would best benefit from this agent among the options provided is the 34-year-old man with renal insufficiency and moderate back pain (Option C). The correct answer, Option C, is the best choice because tapentadol undergoes hepatic metabolism and does not require renal dose adjustments. In patients with renal insufficiency, drugs that are primarily eliminated through the kidneys may accumulate and lead to toxicity. Therefore, tapentadol is a safer choice for this patient compared to other analgesics. Option A is incorrect because patients with end-stage liver disease may have impaired drug metabolism and clearance, increasing the risk of adverse effects with tapentadol use. Option B is incorrect because patients with hepatitis may also have compromised liver function, affecting drug metabolism and increasing the risk of toxicity. Option D is incorrect because in a patient with metastatic liver cancer to multiple organs, there may be concerns about drug interactions, organ dysfunction, and overall prognosis, making tapentadol a less favorable choice. In an educational context, understanding the pharmacokinetics and pharmacodynamics of analgesic agents is crucial in selecting the most appropriate treatment for patients with complex medical conditions. Tailoring drug therapy based on individual patient factors such as organ function, comorbidities, and drug interactions is essential for optimizing outcomes and minimizing adverse effects.