Sample Answer for NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 2 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.
A Sample Answer For the Assignment: NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 2
Title: NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 2
Generalized anxiety disorder (GAD), a chronic condition, frequently starts in adolescence or the early stages of adulthood and lasts the rest of one’s life (Strawn et al., 2018). The medications include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). These are Antianxiolytics, which typically affect the brain’s neurotransmitters inhabiting reuptakes in terms of their pharmacokinetics and pharmacodynamics.
Selective Serotonin Reuptake Inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered the first line of drugs to treat generalized anxiety disorder. The main mechanism of action of SSRIs is to prevent presynaptic serotonin reuptake at the serotonin transporter, which raises serotonin levels at the postsynaptic membrane in the serotonergic synapse (Edinoff et al., 2021). These medications include fluoxetine, Citalopram, escitalopram, paroxetine, sertraline, and fluvoxamine. These medications treat generalized anxiety disorder using the same mechanism. However, each of them has unique pharmacokinetics and pharmacodynamics. The half-life of each drug varies, for instance, fluoxetine’s half-life is 1 to 4 days, whereas Citalopram’s half-life is 26 hours. SSRIs tend to be metabolized by cytochrome P450 in the liver. SSRIs tend to have better specificity than MAOIs and TCAs, which makes them the drug of choice for treating depression as well. The side effects of these medications include weight gain, sleepiness, and dry mouth.
Different Treatment Options:
Antihistamines, such as Hydroxyzine are one of the most common FDA-approved medications that could be used for anxiety as well. Antihistamines, such as hydroxyzine, are histamine-1 receptor (H1) blockers that are frequently used as an alternative to benzodiazepines for anxiety, panic attacks, and sleeplessness (Garakani et al., 2020). Though antihistamines are used for allergy symptoms, Hydroxyzine and Diphenhydramine (Benadryl) may be safer for adolescents and in pregnancy for anxiety symptoms as well. Aside from side effects including dry mouth, constipation, and sedation, antihistamines are generally well tolerated.
Cannabis may have potential therapeutic effects in treating anxiety. Cannabis is known for its pleasurable and calming effects. Additionally, preclinical studies show that CBD has antidepressant effects after both acute and long-term dosing (Martin et al., 2021). The use of cannabis and other cannabinoids is accepted as a safe means of promoting relaxation and reducing anxiety, however there is not much literature or evidence that supports that.
Benzodiazepines are one the treatment for anxiety and remain one of the most commonly used classes of psychiatric drugs worldwide. Benzodiazepines, which function as GABA-A agonists, are very adaptable drugs that can be administered for a variety of disorders. They can be used for mania, insomnia, anxiety, agitation, and seizures. However, antidepressant effectiveness may be decreased by long-term usage of benzodiazepines to treat anxiety and co-morbid depression (Garakani et al., 2020).
Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., Kaye, A. D., Viswanath, O., Urits, I., Boyer, A. G., Cornett, E. M., & Kaye, A. M. (2021, August 5). Selective serotonin reuptake inhibitors and adverse effects: A narrative review. Neurology international. Retrieved January 14, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8395812/
Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020, December 23). Pharmacotherapy of anxiety disorders: Current and emerging treatment options. Frontiers in psychiatry. Retrieved January 15, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786299/#:~:text=in%20anxiety%20disorders.-,Antihistamines,approved%20for%20use%20in%20anxiety.
Martin, E. L., Strickland, J. C., Schlienz, N. J., Munson, J., Jackson, H., Bonn-Miller, M. O., & Vandrey, R. (2021, September 9). Antidepressant and anxiolytic effects of medicinal cannabis use in an observational trial. Frontiers in psychiatry. Retrieved January 15, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8458732/
Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018, July). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: An evidence-based treatment review. Expert opinion on pharmacotherapy. Retrieved January 14, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340395
A Sample Answer 2 For the Assignment: NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 2
Title: NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 2
Thank you for starting the discussion, Jinkle. How long should the clinician allow a SSRI or SNRI to work before making a conclusion about its efficacy for a patient, assuming the patient reports that they are taking it as directed?
GAD is a chronic condition characterized by uncontrollable worrying. (Rosenthal 2018, p.243). Most patients with GAD also have another psychiatric disorder, depression. It usually involves a persistent feeling of anxiety or dread that interferes with how you live your life. “It is not the same as occasionally worrying about things or experiencing anxiety due to stressful life events. People living with GAD experience frequent anxiety for months, if not years. GAD develops slowly. It often starts around age 30, although it can occur in childhood. The disorder is more common in women than in men.” (NIH of Mental Health). Good news, it’s treatable. SSRIs and SNRIs are the first line treatment for GAD.
Of the 13 benzodiazepines available, 6 are approved for anxiety. Benzodiazepines are second-line drugs for anxiety called central nervous system depressants. “They raise levels of an amino acid in your brain called gamma-aminobutyric acid (GABA). blocks other activity in your brain, which helps you feel calm and can make you sleepy. Anxiolytic effects develop slowly with first initial responses to show within a week.They are distinguished by their pharmacokinetics and their metabolism to a large extent; condition their use [3]. These are weak acids of variable constant dissociation with a high lipophilicity, which allows rapid passage through the membranes (blood-brain and placental barriers, and passage in breast milk). ” (Bourin, 2018).
Pregabalin can be used for epilepsy and neuropathy pain, as well as GAD. Pregabalin exerts its anxiolytic effects by potently binding to the alpha2-delta subunit of the voltage-gated N-and P/Q-type calcium channels in central nervous system (CNS) tissue. This causes a decrease in presynaptic calcium currents which modulates the release of neurotransmitters, including glutamate, substance P, and calcitonin gene-related peptide from excited neurons. A decrease in scores on the Hamilton Anxiety Rating Scale was noted with pregabalin within a week and was effective on both somatic and psychic symptoms; shown to be effective in patients over 65 years of age.
References
Bourin, M. (2018, February 12). Clinical Pharmacology of anxiolytics. Archives of Depression and Anxiety. Retrieved January 16, 2023, from https://www.peertechzpublications.com/articles/ADA-4-129.phpLinks to an external site.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
U.S. Department of Health and Human Services. (n.d.). Generalized anxiety disorder: When worry gets out of Control. National Institute of Mental Health. Retrieved January 16, 2023, from https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad
Thank you for your post, Hannah. Benzodiazepines can be used for augmentation during acute treatment of GAD, but they can be problematic over the long term due to dependence and the development of tolerance. For this reason and as you noted, SSRIs/SNRIs, and buspirone are better first-line options for the long term management of GAD.
A Sample Answer 3 For the Assignment: NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 2
Title: NURS 6521 COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER 2
Great post! You bring up some interesting points regarding GAD and its treatment options. Benzodiazepines are commonly prescribed drugs for GAD. They are sedating drugs that contributes to rapid relief for anxiety as well as insomnia. Though they are part of anxiety treatments, they come with long term and short term adverse effects, which makes them a second line drug of choice. With Benzodiazepines, physical dependence and tolerance is high. As you mentioned, anxiolytic effects works slow and take a while to have an effect, hence the tolerance is build up over time with such medications. In the hopes that once a therapeutic dose is reached, Benzodiazepines can be discontinued, SSRIs are frequently used as an adjunct therapy for the first few weeks rather than as the primary medication regimen (Guina & Merrill, 2018)
SSRIs, such as escitalopram (Lexapro) have been considered as the first line of treatment for GAD or SNRIs such as venlafaxine. Both are effective and well tolerated by the vast majority of patients, both adults and children. SSRIs alter the chemistry of your brain by delaying the re-absorption of the neurotransmitter serotonin, which is believed to help control mood and anxiety. SSRIs are also recommended for pediatric patients to relieve mood disorders and anxiety in children. Children with anxiety disorders are more likely to develop other anxiety disorders, depression, and substance abuse in the future, and they also perform poorly academically (Bushnell et al., 2018). Metabolite-to-parent ratios were lower in women taking oral contraceptives and escitalopram compared to those who were only taking escitalopram by itself (Strawn et al., 2021). Taking SSRIs with other medications may also affect plasma levels significantly. For instance, taking PPIs and Escitalopram could increase plasma levels.
Guina, J., & Merrill, B. (2018, January 30). Benzodiazepines I: Upping the care on Downers: The evidence of risks, benefits and alternatives. Journal of clinical medicine. Retrieved January 17, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852433/
Strawn, J. R., Poweleit, E. A., Uppugunduri, C. R. S., & Ramsey, L. B. (2021, October 1). Pediatric therapeutic drug monitoring for selective serotonin reuptake inhibitors. Frontiers in pharmacology. Retrieved January 17, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8517085/
Bushnell, G. A., Compton, S. N., Dusetzina, S. B., Gaynes, B. N., Brookhart, M. A., Walkup, J. T., Rynn, M. A., & Stürmer, T. (2018). Treating pediatric anxiety: Initial use of ssris and other Antianxiety prescription medications. The Journal of clinical psychiatry. Retrieved January 17, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468981/