Posted: November 28th, 2022

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Discussion: Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder

Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.

Generalized Anxiety Disorder is a psychological condition that affects 6.1 million Americans, or 3.1% of the US Population. Despite several treatment options, only 43.2% of those suffering from GAD receive treatment. This week you will review several different classes of medication used in the treatment of Generalized Anxiety Disorder. You will examine potential impacts of pharmacotherapeutics used in the treatment of GAD. Please focus your assignment on FDA approved indications when referring to different medication classes used in the treatment of GAD.

To Prepare

Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.

Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.

Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.

Think about a personalized plan of care based on these influencing factors and patient history with GAD.

By Day 6 of Week 8

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients diagnosed with GAD. In addition, suggest different treatment options you would suggest to treat a patient with the topic of discussion.

Colleague 1

COLLAPSE

Generalized anxiety disorder (GAD) is excessive anxiety over life events such as outward performance in school, work, marriage, social status, and including but not limited to finances; its prevalence is higher amongst high-income countries, higher incidence levels amongst women, and usually emerge in the early 20s (Rosenthal and Burchum, 2017). Signs and symptoms of GAD include irritability, restlessness, fatigue, problems with sleep, difficulty concentrating, and muscle tension; severe impairments can impact the quality of life and impact physical and emotional wellness (Chen, et. al., 2019). Non-drug therapy approaches of treatment include supportive therapy, cognitive behavioral therapy, reinforcing and educating patients on effective coping skills, and relaxation training; when symptoms become disabling, medication therapy is indicated. Medications approved for treatment include benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs).

In personal experience related to patient diagnosis of GAD, the patient was an African American middle-aged woman with multiple comorbidities including comorbid psychiatric diagnosis. The patient was on several mood suppressive drugs at high doses due to a history of schizophrenia, suicidal and homicidal tendencies and attempts, as well as diabetes, hypertension, heart failure, and obesity to further add to the complexity of ineffective therapy interventions. The patient had several episodes of medication non-compliance and during this shift, had a behavioral outburst requiring as needed Ativan 5 mg daily for the behavioral outburst. The significance of the pharmacodynamics was the fact the patient was on one of the highest doses possible due to the high tolerance of the patient and the factors of the comorbidities. Anxiolytics do accumulate in the blood and must be prescribed with care; the patient in question was tall in stature and girth, with a prior history of substance abuse; “A frequent complication of GAD is substance abuse, which may result from self-medication with alcohol or drugs to relieve anxiety symptoms” (Huether & McCance,2019, pg. 613). Further treatment interventions for the patient would have been supportive therapy, cognitive and behavioral therapy, as well as individual therapy to teach and evaluate effective coping skills.

Colleague 2

Generalized anxiety disorder (GAD) occurs more frequently in middle-aged, widowed, or divorced females, with the ratio of females to males being 2:1 (Wilson & Stein, 2019). Genetics has been shown to play a role in the expression of GAD, influencing approximately 31% of emergence, as shown in twin studies. The overall prevalence in the United States is 4.1%, with symptoms being chronic and remission rates of only about 20%. The treatment goal is to improve the symptoms and improve function (AHC Media, 2021).

The first-line medications used to treat GAD in the U.S. are selective serotonin reuptake inhibitors (SSRIs) followed by serotonin-norepinephrine reuptake inhibitors (SNRIs). The SSRIs are Escitalopram (Lexapro) and Paroxetine (Paxil), the SNRIs are Duloxetine (Cymbalta) and Venlafaxine (Effexor), and the Azapirone Buspirone (BuSpar) (Wilson& Stein, 2019). There is an increased risk of suicidal ideations and other adverse effects such as insomnia and restlessness in children and adolescents treated with SSRIs, but this is not the case with SNRIs (Abubakar et al., 2021). In the elderly, altered pharmacokinetics such as delayed absorption and decreased excretion must be considered when initiating therapy and drug-drug interactions reviewed. Buspirone is frequently used in addition to SSRIs/SNRIs instead of a benzodiazepine due to it having no potential for abuse but is not generally used as first-line therapy (AHC Media, 2021). Females tend to have higher CYP2D6 and CYP3A4 activity, increasing the clearance of SSRIs/SNRIs but have a lower glomerular filtration rate which slows the elimination of some metabolites. Females are also more prone than males to QT interval elongation, so QT must be monitored with some SSRIs/SNRIs (Wilson & Stein, 2019).

Benzodiazepines are considered second-line drugs in the treatment of GAD. They are highly effective at reducing the symptoms of GAD but have a high rate of abuse, dependence, and withdrawal and should only be used in severe or acute episodes of GAD (AHC, 2021). This class of medication is also contraindicated when the patient takes other psychoactive substances or drinks alcohol (Abubaker et al., 2021).

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Discussion: Pharmacologic Treatment Options for Generalized Anxiety Disorder Comparison and Contrast

For individuals of all ages, psychological problems such as depression, bipolar disorder, and anxiety disorders can cause a variety of issues. Patients are affected physically and emotionally by these diseases, which may have an influence on judgment, school and/or job performance, and relationships with family and friends. Because these conditions have such a large impact on patients’ lives, advanced practice nurses must be able to properly manage patient care. It is the advanced practice nurse’s role to ensure the safe and effective diagnosis, treatment, and education of patients with psychiatric problems, taking into account patient variables and medical history.

Generalized Anxiety Disorder (GAD) is a psychological disorder that affects 6.1 million people in the United States, or 3.1% of the population. Despite the availability of various therapeutic options,