Sample Answer for COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER NURS 6521 Included After Question
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
A Sample Answer For the Assignment: COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER NURS 6521
Title: COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER NURS 6521
Summary of Patient Case Study
A 71-year-old Asian man with a history of GAD, which was caused by diabetes and hypertension, was presented to our inpatient psychiatric clinic. He was mainly brought for stabilization and long-term medication. The information gathered from the family stated that the patient had refused oral food intake for about thirty hours, was isolative in his room, and had increased confusion. The diagnosis also showed a history of GAD in the patient’s family, especially among aged people. After admitting him to our clinic, the clinical presentation of the patient depicted a transformed level of consciousness. I took three imperative decisions I thought could help him. They include: stabilizing him, performing psychotherapy, and administering relevant medication.
Evaluation of My Decisions
I believe the decisions I provided were supported by evidence-based literature. According to Watts et al. (2020), psychotherapy involves working with therapists to reduce the level of GAD. For example, in our case, I recommended the therapist to use behavioral therapy because it was the most effective psychotherapy for GAD. On the other hand, stabilizing the patient is imperative because it ensures the conditions of the patient are within the healthy range (Savioli et al., 2020). For example, in our case, I recommended calming the patient to regain his level of consciousness. Lastly, I recommended the patient’s medication because it could ease symptoms and prevent or halt hypertension and diabetic conditions (Wilhelmsen & Eriksson, 2019). Medication was the heart of everything because the patient’s issues were beyond anxiety disorders.
Objectives of My Decisions
First, I hoped behavioral therapy could help the patient manage various GAD-related symptoms, such as anxiety and stress. I also expected this treatment option could help the patient cope with negative emotions. Second, I hoped the medication decisions I recommended, such as Crestor 20mg daily, Lantus insulin 10 units daily, Metformin 70mg daily, Lithium 300mg daily, and hydrochlorothiazide 25mg daily, could help the patient improve his hypertension and diabetic conditions. Lastly, I hoped the patient would be stable after recommending a stabilization program in the emergency room. I also expected his pressure to normalize after calming him by providing personal attention.
Differences between Expectations and Results
In psychotherapy, the expected results were attained. For example, the patient coped with adverse emotions and managed his anxiety and stress. He calmed down and started conversing with me. On the other hand, the prescribed medication also responded positively as planned. For example, in this decision, I aimed to improve the patient’s diabetic condition, which came down to manageable levels. Therefore, there was no difference between the anticipated and results. Lastly, the objectives of my decision to stabilize the patient aligned with the outcomes. For example, the patient’s hypertension was very high, but I managed to bring it to normal levels.
Pharmacokinetics and Pharmacodynamics Processes
In the pharmacokinetics process, the medication I recommended, especially oral medication, undergoes three stages. Absorption is the first stage, where the medicine is ingested and passed through the stomach into the intestine linings. The second stage is distribution, where the drugs pass through the liver and intestines into the bloodstream. The third stage is metabolism, where the drug undergoes glucuronidation and oxidation. The last stage is the excretion of the medicine, mainly through the functioning of the kidney. The pharmacodynamics commences when the drug reaches the target organ or tissue. The drug may involve enzyme inhibition or cause presynaptic or postsynaptic effects on the patient. The final part of pharmacodynamics involves cellular response and signal transduction.
COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER NURS 6521
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giving treatment. Situational anxiety can be normal and is common. Like for example:
feeling anxious with job interview, first day of school or giving presentation to a class or
large group. The pharmacologic treatment are the following: Xanax (Alprazolam),
Klonopin (Clonazepam), Ativan (Lorazepam)-to manage anxiety attack. Psychotherapy
is recommended such as: Cognitive- Behavioral therapy or exposure therapy (Cherry,
K.2020).
I have resident here in Assisted living- a 93 year old Caucasian female who were
admitted in the facility with a Diagnosis of Anxiety Disorder, Unspecified. She is
coherent, conversant and independent of her ADLs. This resident has no other health
issues but when anxiety attack especially in the afternoon she would walk and find a
way to release her anxiety until she had an incident of fall which she had hip and arm
fracture.
A Sample Answer 2 For the Assignment: COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER NURS 6521
Title: COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER NURS 6521
Generalized anxiety disorder is a chronic illness characterized by pervasive, widespread anxiety affecting several domains. It usually begins in adolescence or early adulthood and persists throughout life (Strawn et al., 2018). In terms of management, both psychotherapy and pharmacotherapy methods should be used together for maximum outcomes. Drugs used for the management of GAD include antidepressants like Selective serotonin reuptake inhibitors (SSRIs), Selective serotonin-norepinephrine reuptake inhibitors (SSNRIs), benzodiazepines, monoamine oxidase inhibitors (MAOi), tricyclics antidepressants (TCAs), and second-generation antipsychotics (Melaragno, 2021). The first line is either an SSRI or SNRI. The purpose of this paper is to compare various GAD pharmacotherapies.
Comparison
Most of the agents used in the management of GAD function by increasing serotonin concentration except for benzodiazepines (Stein, 2021). SSRIs inhibit serotonin reuptake hence increasing the synaptic concentration, SSNRIs inhibit the reuptake of both norepinephrine and serotonin, second-generation agents like olanzapine and risperidone inhibit both dopamine and serotonin receptors thus increasing their concentrations, MAOi inhibit the enzyme monoamine oxidase which deactivates dopamine, serotonin, and norepinephrine thus increasing their concentrations, and TCAs block norepinephrine transporter and are potent inhibitors of serotonin reuptake (Garakani et al., 2020). Benzodiazepines bind GABA A receptors and act as allosteric modulators hence potentiating the effects of endogenic GABA. In both long and short terms of treatment, SSRIs have a broad spectrum in terms of efficacy, TCAs have a slow onset of anxiolytic action and a wide range of adverse effects on the other hand benzodiazepines have been discouraged because of the risk of drug dependence.
Conclusion
In adults, either SSRIs or SNRIs can be the first-line agents while in the pediatric age group, the first-line drug is an SSRI. Newer agents with better pharmacologic profiles are being discovered, the latest of which is agomelatine which is both a melatonin receptor agonist and a serotonin receptor antagonist. It has efficacy and tolerability profiles that compare favorably with escitalopram.
References
Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: Current and emerging treatment options. Frontiers in Psychiatry, 11, 595584. https://doi.org/10.3389/fpsyt.2020.595584
Melaragno, A. J. (2021). Pharmacotherapy for anxiety disorders: From first-line options to treatment resistance. Focus (American Psychiatric Publishing), 19(2), 145–160. https://doi.org/10.1176/appi.focus.20200048
Stein, D. J. (2021). Evidence-based pharmacotherapy of generalised anxiety disorder: Focus on agomelatine. Advances in Therapy, 38(Suppl 2), 52–60. https://doi.org/10.1007/s12325-021-01860-1
Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057–1070. https://doi.org/10.1080/14656566.2018.1491966
A Sample Answer 3 For the Assignment: COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER NURS 6521
Title: COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER NURS 6521
Anxiety disorder is among the most widespread psychiatric disorders and the most prevalent cause of disability. Although research concerning depression and post-traumatic stress disorder (PTSD) has been commenced, different medications are under investigation for anxiety disorders like Generalized Anxiety Disorder (GAD). GAD is popular among the United States Citizens. According to Simon et al. (2020), the World Health Organization reports that anxiety disorders have impacted about 265 million individuals in the US. As for the pharmacodynamics and pharmacokinetics of anxiolytics and mental health, different medications work on a neurotransmitter in the brain. These medications are critical in ensuring synapses are firing to boost anxiety symptoms and mood. This work intends to highlight the pharmacodynamics and pharmacokinetics of medications and compare and contrast various options of treatment that can be utilized and approved by FAD.
Selective serotonin-norepinephrine reuptake inhibitors (SNRIs) are indicated as one of the essential first-line medications based on their favorable advantage-to-risk ratio. Patients must be aware that the effect of anxiolytics of such antidepressants takes up to approximately 2-4 weeks to show (Kim, 2020). However, the adverse impacts can be more serious in the first two weeks. Original jitteriness and increased anxiety symptoms can happen, thus lowering the patient’s compliance with treatment. In this situation, reducing the beginning of antibodies can improve the side effects. Nonetheless, based on clinical evidence, tolerance differs based on the patient, and the person may suffer fewer side effects if they switch from SSRI to SNRI (Rosenthal & Burchum, 2021, p.246). Furthermore, the withdrawal signs may grow after stopping the therapy of SSRI. However, these symptoms tend to be less common than and serious compared to the withdrawal signs that happen when the medication of benzodiazepine stops.
When treating anxiety disorder, the imipramine and clomipramine tricyclic antidepressants (TCAs) can be effective and can be termed as 2nd generation antidepressants. On average, TCAs have an increased rate of different side impacts compared to SNRIs and SSRIs (Rosenthal & Burchum, 2021, p. 217). Consequently, before someone utilizes TCAs, there is a need to try these medications. Gradually, as time goes on, the dose of the medication can be increased up to the recommended appointment. Also, based on the possibility of lethal toxicity due to overdose, TCAs must be cautiously administered among patients at high risk of suicide.
Benzodiazepines are highly personalized. To some level, they can be characterized through their metabolism; hence, they should be utilized carefully. They are weak acids that have increased lipophilicity (Van Ameringen et al., 2017). Patients who have a history of benzodiazepine or any substance abuse need not undergo treatment. Benzodiazepines can always be administered in conjunction with SNRIs and SSRIs.
Buspirone, a 5-HT1A agonist grouped as azapirone, is approved by the FDA for treating anxiety. Buspirone is usually an adjunctive treatment with SSRIs and SNRIs, majorly for GAD. According to Van Ameringen et al. (2017), azapirone is the only treatment that can be approved. Buspirone was discovered to be more powerful than placebo. However, it has a reduced effect on GAD compared to antidepressants and benzodiazepines (Rosenthal & Burchum, 2021, p. 229).
In conclusion, individuals with Generalized Anxiety Disorder (GAD) fear different things instead of particular situations or objects, hence the term “generalized” anxiety. This may result in a considerable emotional effect and bodily impact, including muscle tightness and sleepiness. Constant aspects may be taxing. However, different treatments can be essential in reducing anxiety levels, including Buspirone, Benzodiazepines, and tricyclic antidepressants.
References
Kim, Y. (2020). Anxiety disorders: Rethinking and understanding recent discoveries. Springer Nature.
Rosenthal, L., & Burchum, J. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). St. Louis, MO: Elsevier.
Simon, N., Hollander, E., Rothbaum, B. O., & Stein, D. J. (2020). The American Psychiatric Association published anxiety, trauma, and OCD-related disorders textbook. American Psychiatric Pub.
Van Ameringen, M., Patterson, B., Turna, J., Pipe, A., & Nakua, H. (2017). The treatment of refractory generalized anxiety disorder. Current Treatment Options in Psychiatry, 4(4), 404-417. https://doi.org/10.1007/s40501-017-0129-6
Grading Rubric
| Performance Category | 100% or highest level of performance
100% 16 points |
Very good or high level of performance
88% 14 points |
Acceptable level of performance
81% 13 points |
Inadequate demonstration of expectations
68% 11 points |
Deficient level of performance
56% 9 points
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Failing level
of performance 55% or less 0 points |
| Total Points Possible= 50 | 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic topics. |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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Presentation of information is unsatisfactory in three or more of the following elements
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| 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points | |
| Application of Course Knowledge
Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in the all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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Presentation of information is unsatisfactory in three of the following elements
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| Interactive Dialogue
Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic. |
Demonstrated all of the following:
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Demonstrated 3 of the following:
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Demonstrated 2 of the following:
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Demonstrated 1 or less of the following:
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| Grammar, Syntax, APA
Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error. |
The following was present:
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| Participation
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| Due Date Requirements | Demonstrated all of the following:
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Demonstrates one or less of the following.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |