Welcome to NP Certification Q&A presented by Fitzgerald Health Education Associates. This podcast is for NP students studying to pass their NP certification exam. Getting to the correct test answers means breaking down the exam questions themselves. Leading NP expert Dr. Margaret Fitzgerald shares her knowledge and experience to help you dissect the anatomy of a test question so you can better understand how to arrive at the correct test answer. So if you're ready, let's jump right in.  

In treating a 26-year-old man with panic disorder who is otherwise healthy. You can consider prescribing: 

A. Bupropion
B. Alprazolam
C. Citalopram
D. Risperidone  

Where do you start? 

Determine what kind of question this is. Given the question, direct therapy of a person with a new diagnosis, this is an initial treatment plan. 

First, let's review the information provided. When we’re told that the person has a diagnosis of panic disorder. Please, on board questions, assume that that data provided is correct. The person does in fact have panic disorder. 

To meet the DSM five criteria for panic disorder, panic attacks must be associated with a longer than one month of subsequent persistent worry about: one: having another attack or consequences of an attack, and or two: significant maladaptive behavioral changes related to the attack. And examples of that would be first panic attack is had while driving a car and now the person won't drive a car anymore for fear of having another panic attack. In addition, this presentation cannot be contributed to another cause. We're also told he is otherwise healthy and therefore without conditions that could worsen or mimic panic disorder such as substance use disorder, including alcohol withdrawal, or another disease such as hyperthyroidism. 

 Given that this is an initial therapy question, your choices should be aimed at first line intervention. Let's take a look at the options. At first, you might be struck with being given a short list of commonly prescribed psychotropics, but analyzing the choices and the characteristics of each medication will help you choose the best answer. 

 A: Bupropion, trade name Wellbutrin. Bupropion is a selective dopamine reuptake inhibitor can have some utility in the treatment of panic disorder, but is not considered to be a first-line therapy. The point is you might bupropion as an add-on drug in the treatment of panic disorder, but it is not considered a first-line drug. 

 B: Alprazolam. This is a benzodiazepine and Alprazolam has the “am” suffix that the majority of the benzos have on it. They are not considered first-line for panic disorder. These agents are considered for adjunctive therapy with special consideration regarding the adverse effects and potential for dependence. 

 C: Citalopram, this is trade name Celexa. This is the correct answer. Selective serotonin reuptake inhibitors (SSRI) is the drug class that is the first-line therapy for panic disorder. This drug class is generally well-tolerated, safe, and effective. 

 D: Risperidone. Risperidone (trade name Risperdal) is a second-generation antipsychotic (SGA) indicated for a variety of psychiatric conditions; but it's not considered to be a first-line therapy in panic disorder. SGAs are often used as adjunctive therapy when first-line therapy is ineffective. But we, in this question, are choosing the first-line therapy.  

 Option C, Citalopram is of course the correct answer. 

 Key takeaway: In order to answer a question on developing an initial treatment plan, knowledge of first-line therapies for commonly encountered clinical conditions is critical. 

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