CNS Pharmacology USMLE Step 1 Practice Question
A 28-year-old woman with a 2-year history of generalized anxiety disorder presents to discuss medication management in anticipation of pregnancy. She has been stable on lorazepam 2 mg daily for 6 months with good symptom control. Vital signs are normal. Urine pregnancy test is negative, and she denies suicidal ideation, substance abuse, or psychiatric comorbidities. She is concerned about the safety of her current medication if she becomes pregnant and asks whether she should switch to a different anxiolytic. Which of the following best addresses her concern regarding benzodiazepine use in pregnancy?
Answer choices
- AContinue lorazepam throughout pregnancy, as benzodiazepines are FDA Category A and have no teratogenic risk
- BDiscontinue lorazepam now and initiate buspiron, which has better safety data in the first trimester
- CSwitch to diazepam because its longer half-life reduces fetal exposure and maternal withdrawal symptoms
- DAvoid all benzodiazepines due to increased risk of cleft palate and neonatal withdrawal; optimize psychotherapy and consider SSRIs as preferred alternativeCorrect answer
- ESwitch to phenobarbital, which has FDA Category B designation and is the standard choice for anxiety in pregnancy
- FTaper and discontinue lorazepam prior to conception, then reinitiate only if anxiety is severe, using short-acting agents to minimize fetal exposure
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