A 35-Year-Old Man Comes to the Office for Increasing Anxiety

question 379

Multiple Choice

A 35-year-old man comes to the office for increasing anxiety associated with public speaking.  The patient previously worked in product development but was recently promoted to a leadership sales position that requires leading daily team meetings and frequent public speaking.  When speaking before a group of people, the patient becomes extremely anxious; his face turns bright red; he starts to sweat profusely; and he feels that his heart is racing.  He also becomes acutely aware that other people notice his anxiety and judge him negatively.  The patient reports that he has been uncomfortable in large groups and while meeting new people since he was a teenager.  His new job has been very stressful as he can no longer avoid these situations.  He recognizes that his anxiety and fear of public speaking are excessive.  The patient has no depression and is otherwise healthy.
Blood pressure is 118/68 mm Hg and pulse rate is 86/min.  BMI is 23 kg/m².  The remainder of the physical examination is unremarkable.
Which of the following is the most appropriate pharmacologic treatment in management of this patient?

• A)Alprazolam
• B)Buspirone
• C)Clonazepam
• D)Propranolol
• E)Sertraline

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Definitions:

Mg/dL

Milligrams per deciliter, a unit of measurement commonly used in blood and other bodily fluid analyses to quantify the concentration of substances.

International Normalized Ratio (INR)

A measure used in blood tests to determine the clotting tendency of blood, helping to monitor and adjust the dose of anticoagulants.

Prothrombin Time (PT)

A blood test measure that evaluates how long it takes blood to clot, primarily used to assess blood coagulation pathways.

Creatinine Kinase (CK)

An enzyme found in the heart, brain, skeletal muscle, and other tissues, used as a marker of muscle injury.