WBR0788

Author	[[PageAuthor::Serge Korjian M.D. (Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Behavioral Science/Psychiatry, MainCategory::Pharmacology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 33-year-old man complains of excessive worry that often interferes with his daily functioning. He finds himself anticipating disasters, and worrying about everything from health issues, to money, death, and relationship troubles. He is diagnosed with generalized anxiety disorder and his psychiatrist decides to initiate treatment. The patient seems reluctant because he hates medications and would like an agent that would not cause him to become sleepy throughout the day, and would not be addictive on the long run. Which of the following medications could be used offered to this patient?]]
Answer A	AnswerA::Alprazolam
Answer A Explanation	AnswerAExp::Alprazolam is a benzodiazepine with high risk of sedation, addiction, and tolerance.
Answer B	AnswerB::Imipramine
Answer B Explanation	AnswerBExp::Imipramine is a TCA with significant sedative effects. TCAs are not indicated for GAD.
Answer C	AnswerC::Desipramine
Answer C Explanation	AnswerCExp::Desipramie is a TCA with less sedative effects that other TCAs but still significant compared to buspirone. TCAs are not indicated for GAD.
Answer D	AnswerD::Buspirone
Answer D Explanation	AnswerDExp::Buspirone is used for GAD with no risk of addiction or sedative effects.
Answer E	AnswerE::Maprotiline
Answer E Explanation	AnswerEExp::Maprotiline is an antidepressant that blocks norepinephrine re-uptake. It is not indicated for GAD. It causes significant sedation.
Right Answer	RightAnswer::D
Explanation	[[Explanation::Buspirone is an anxiolytic drug used mainly in the treatment of generalized anxiety disorder. Compared to other treatments, it was shown to be effective in mild to moderate GAD however, it is particular in that it is nonsedative even causing insomnia in some patients. Buspirone also has very low risk of addiction of tolerance. The mechanism of action of buspirone is poorly understood. It acts as serotonin 5-HT1A receptor agonist but also possesses α1 receptor agonist and dopamine antagonist properties. A common mneumonic used to remember the characteristics of buspirone is "I SAT on the BUS". SAT stands for NO sedation, addiction, or tolerance. Educational Objective: Buspirone alleviates anxiety without causing sedation, addiction or tolerance. References: Eison AS, Temple DL. Buspirone: review of its pharmacology and current perspectives on its mechanism of action. The American Journal of Medicine. 1986;80(3):1-9.]]
Approved	Approved::Yes
Keyword	WBRKeyword::Buspirone, WBRKeyword::Sedation, WBRKeyword::Tolerance, WBRKeyword::Addiction, WBRKeyword::Anxiolytics, WBRKeyword::Anxiolytic
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