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.

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

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.

Photo Credit: Getty Images/iStockphoto

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. 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 3 of Week 8

Post a discussion of pharmacokinetics and pharmacodynamics related to anxiolytic medications used to treat GAD. In your discussion, utilizing the discussion highlights, compare and contrast different treatment options that can be used.

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.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria

To access your rubric:
Week 8 Discussion Rubric

Post by Day 3 of Week 8 and Respond by Day 6 of Week 8

There are four interactive media files accessible from the week 8 resources: adult geriatric depression, ADHD, bipolar therapy, and generalized anxiety disorder (GAD). By Wednesday create a discussion post explaining the differences between different anxiolytic medications used in the treatment of GAD as it relates to pharmacokinetics and pharmacodynamics. The interactive media file will be helpful for this assignment. By Saturday, respond to two different classmates’ initial posts.

This is the case study for this Class discussion

BACKGROUND INFORMATION

The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL.
He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at.

In your office, he confesses to occasional use of ETOH to combat worries about work. He admits to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26.

Client has never been on any type of psychotropic medication.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.

You administers the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder

RESOURCES
§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Decision Point One
Select what you should do:

Begin Zoloft 50 mg po daily

Begin Imipramine 25 mg po BID

Begin Buspirone 10 mg po BID

Decision Point One

Begin Zoloft 50 mg orally daily
RESULTS OF DECISION POINT ONE

Client returns to clinic in four weeks
Client informs you that he has no tightness in chest, or shortness of breath
Client states that he noticed decreased worries about work over the past 4 or 5 days
HAM-A score has decreased to 18 (partial response)
Decision Point Two

Increase dose to 75 mg orally daily
RESULTS OF DECISION POINT TWO

Client returns to clinic in four weeks
Client reports an even further reduction in his symptoms
HAM-A score has now decreased to 10. At this point- continue current dose (61% reduction in symptoms)
Decision Point Three
Select what you should do next:

Maintain current dose
Increase current dose of medication to 100 mg orally daily
Add augmentation agent such as BuSpar (buspirone)

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
⦁ Chapter 26, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 203–213)
⦁ Chapter 27, “Antidepressants” (pp. 214–226)
⦁ Chapter 28, “Drugs for Bipolar Disorder” (pp. 228–233)
⦁ Chapter 29, “Sedative-Hypnotic Drugs” (pp. 234–242)
⦁ Chapter 30, “Management of Anxiety Disorders” (pp. 243–247)
⦁ Chapter 31, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 248–254)

Required Media (click to expand/reduce)

Laureate Education (Producer). (2019a). Adult geriatric depression [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat adult geriatric depression.

Laureate Education (Producer). (2019c). Attention deficit hyperactivity disorder [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat attention deficit hyperactivity disorder.

Laureate Education (Producer). (2019d). Bipolar therapy [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics for bipolar therapy.

Laureate Education (Producer). (2019g). Generalized anxiety disorder [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat generalized anxiety disorder.

Speed Pharmacology. (2016). Pharmacology – Antidepressants – SSRIs, SNRIs, TCAs, MAOIs, Lithium (Made Easy) [Video]. https://www.youtube.com/watch?v=T25jvLC6X0w&t=3s
Note: This media program is approximately 19 minutes.

Speed Pharmacology. (2018). Pharmacology – Benzodiazepines, Barbiturates, Hypnotics (Made Easy) [Video]. https://www.youtube.com/watch?v=4ZHudeMho8g&t=24s
Note: This media program is approximately 8 minutes.

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