A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 37-year-old woman presents to the general medical clinic with a chief complaint of anxiety. She has been having severe anxiety and fatigue for the past seven months. She has difficulty concentrating and her work has suffered, and she has also developed diarrhea from the stress. She doesn't understand why she feels so anxious and is unable to attribute it to anything specific aspect of her life right now. You decide to begin pharmacotherapy. All of the following are suitable mechanisms of drugs that can treat this illness EXCEPT:
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A
A drug that stimulates 5-HT1A receptorsIncorrect. Drugs that stimulate 5-HT1A receptors (buspirone) are used to treat GAD — appropriate mechanism.
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B
A drug that blocks 5-HT reuptakeIncorrect. Drugs that block 5-HT reuptake (SSRIs) are first-line for GAD — appropriate mechanism.
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C
A drug that blocks both serotonin and norepinephrine reuptakeIncorrect. Drugs that block both serotonin and norepinephrine reuptake (SNRIs) are first-line for GAD — appropriate mechanism.
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D
A drug that blocks dopamine 2 receptorsCorrect. Correct (the EXCEPT). Dopamine D2 receptor antagonists (antipsychotics) are not standard treatment for GAD and are not a recommended mechanism for anxiety disorders.
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E
A drug that blocks GABA reuptakeIncorrect. GABA-reuptake inhibitors (tiagabine) are used as antiepileptics, not as standard treatment for generalized anxiety disorder.
↑ Tap an answer to reveal the reasoning
Answer: D. A patient with chronic worry, fatigue, difficulty concentrating, and GI symptoms (diarrhea) lasting 7 months has generalized anxiety disorder (GAD). First-line pharmacotherapy includes:
- SSRIs (e.g., sertraline, escitaloph alopram, paroxetine) — block 5-HT reuptake
- SNRIs (e.g., venlafaxine, duloxetine) — block both 5-HT and norepinephrine reuptake
- Buspirone — a partial 5-HT1A receptor agonist (stimulates 5-HT1A)
- Benzodiazepines (short-term only; risk of dependence)
Dopamine D2 antagonists (typical antipsychotics, atypical antipsychotics like haloperidol or risperidone) are NOT first-line for GAD. They are used for psychotic disorders, mania, Tourette syndrome, and sometimes refractory anxiety as adjuncts — but they are not a standard or recommended monotherapy mechanism for treating anxiety. They also carry significant risks (EPS, metabolic syndrome, tardive dyskinesia).
So the EXCEPT is the drug that blocks dopamine D2 receptors.
**Why each option:**
**A.** Drugs that stimulate 5-HT1A receptors (buspirone) are used to treat GAD — appropriate mechanism.
**B.** Drugs that block 5-HT reuptake (SSRIs) are first-line for GAD — appropriate mechanism.
**C.** Drugs that block both serotonin and norepinephrine reuptake (SNRIs) are first-line for GAD — appropriate mechanism.
**D.** Correct (the EXCEPT). Dopamine D2 receptor antagonists (antipsychotics) are not standard treatment for GAD and are not a recommended mechanism for anxiety disorders.