Sample Answer for NURS 6521 Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder 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: NURS 6521 Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
Title: NURS 6521 Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
Over the past five years, I have learned that anxiolytic medications like benzodiazepines are commonly prescribed to elderly patients with general anxiety disorders. It is important to carefully consider the benefits and risks entailed in its use. According to Drenth-van Maanen et al. (2019), the pharmacodynamic and pharmacokinetic effects of drugs in the elderly depend on signal transduction, homeostatic regulation, and the number of affinities of target receptor sites, as well as their comorbidities and decline in organ functions. Jain &Maruccan-Sullivan (2019) explained that elderly patients have decreased gastric emptying, intestinal blood flow, hepatic metabolism, creatinine clearance and plasma albumin, so the metabolism, excretion, distribution, and absorption of benzodiazepines are slow, with increased risk for cognitive impairment and sedation. Sobeski (2020) said that ageing decreases drug activation and renal clearance, increases half-life, transit, absorption time of drugs, drug sensitivity, and adverse effects of benzodiazepines due to altered physiological changes. I have seen Lorazepam cause more confusion, falls, hallucinations, and agitation in some of my elderly patients, and worsening of symptoms or rebound side effects should be reviewed.
Plan of care should include psychological evaluation, drug prescription that will not be abused or withdrawn and outweighs the benefits rather than the risks, and consideration of non-pharmacological therapy. Medical comorbidities and drug side effects may mimic anxiety disorders, and proper symptom or clinical presentation assessments are necessary. Rosenthal &Burcham (2019) discussed that generalized anxiety disorders can be controlled with relaxation training, biofeedback, supportive or cognitive behavior therapy, selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), and benzodiazepines medications. Subramanyam et al. (2018) explained that SSRI like Sertraline and Escitalopram are the first line of drugs, SNRI like Duloxetine and Venlafaxine are the second line, and benzodiazepines like Diazepam and Alprazolam should be tapered for short term use and may result in paradoxical agitation or neurocognitive effects like alcohol. Non-pharmacological treatment of anxiety is first recommended rather than pharmacological approaches such as socialization, sleep, environmental interaction, guided imagery, music or art therapy, mindfulness, and nutrition or electrolyte balance. Initiation of fall risk protocol, proper drug dosing, and monitoring of drowsiness, unsteadiness, addiction, and adverse anxiolytic drug effects should also be part of the personalized care plan.
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References
Drenth‐van Maanen, A., Wilting, I., & Jansen, P. F. (2019). Prescribing medicines to older people – how to consider the impact of
ageing on human organs and body functions. British Journal of Clinical Pharmacology, 86(10), 1921–1930.
https://doi.org/10.1111/bcp.14094
Jain, N., &Maruca-Sullivan, P. (2019). Geriatric psychopharmacology prescribing medications in the elderly [PDF]. UCONN Health.
Rosenthal, L. D., &Burchum, J. R. (2021). Lehne’spharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.)
St. Louis, MO: Elsevier
Sobeski, L. (2020). Aging physiology, pharmacokinetics & pharmacodynamics [PDF]. UNMC College of pharmacy.
https://www.unmc.edu/NebraskaGWEP/wp-content/uploads/2020/GWEP_Medication_May-2020-Sobeski.pdf
Subramanyam, A. A., Kedare, J., Singh, O. P., & Pinto, C. (2018). Clinical practice guidelines forgeriatric anxiety disorders.
Indian Journal of Psychiatry, 60(Suppl 3), S371–S382. https://doi.org/10.4103/0019-5545.224476
A Sample Answer 2 For the Assignment: NURS 6521 Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
Title: NURS 6521 Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
Among the anxiolytic medications for generalized anxiety disorder (GAD) are benzodiazepines (BZDs). Concerning their
pharmacodynamic (PD) profiles, BZDs primarily target the γ-aminobutyric acid type A (GABAa) receptor. GABAa receptor is a ligand-gated ion (chloride) channel that is activated by GABA (Scherf-Clavel et al., 2021). When the inhibitory GABArgic activity is stimulated by endogenous ligands, BZDs, or other drugs, it results in amnesia, sedation, ataxia, sleep, and calm feeling (anxiolysis). BZDs’ PD effects include sedation, psychomotor impairment, antiepileptic actions, anterograde amnesia, and muscle relaxation. GABAergic system attenuation leads to restlessness, anxiety, insomnia, and exaggerated reactivity. The elderly are more affected by BZD’s sedation and psychomotor impairment (Neft et al., 2020).
With regards to gender, females have higher plasma concentrations of zolpidem and thus, more psychomotor impairment effects. Thus, low dosages of BZD are recommended for females and the elderly. BZDs’ pharmacokinetics (PK) profiles are influenced by their different physiochemical properties particularly lipid solubility and absorption and diffusion rates. BZDs pass through the blood-brain barrier to equilibrate with the brain tissues (Oka et al., 2021). The two main BDZ biotransformation pathways include oxidation of hepatic microsome, hydroxylation of N-dealkylation or aliphatic hydroxylation, and glucuronide conjugation. The kidney excretes the metabolites. Most BZD’s hydroxylated metabolites are pharmacologically active, with some having long half-lives. The hydroxylation involves various specific enzymes with the main being CYP3A4 and CYP3A5 and CYP2C19, and CYP (Neft et al., 2020).
Another treatment that can be used is selective serotonin reuptake inhibitors (SSRIs). SSRIs block the reuptake of serotonin into neurons, increasing the serotonin available to enhance message transmission between neurons. SSRIs are selected as they main affect serotonin, a neurochemical that regulates mood and anxiety but does not affect other neurotransmitters such dopamine, GABA, or noradrenaline (Kapoor, 2021). SSRIs are newer anxiolytic compared to BZDs. However, despite their usefulness in treating anxiety, SSRIs are known to have delays in the onset of therapeutic effects and can exacerbate anxiety in early treatment (Kapoor, 2021). BZDs on the other hand, have a rapid onset of action but have tolerance and dependence concerns. Thus when prescribing anxiolytics, their PD and PK must be taken into account (Scherf-Clavel et al., 2021).
References
Kapoor, A. (2021). Pharmacokinetics and Pharmacodynamics. In Absolute Geriatric Psychiatry Review (pp. 197-206). Springer, Cham.https://doi.org/10.1007/978-3-030-58663-8_24
Neft, M. W., Oerther, S., Halloway, S., Hanneman, S. K., & Mitchell, A. M. (2020). Benzodiazepine and antipsychotic medication use in older adults. Nursing Open, 7(1), 4.doi: 10.1002/nop2.425
Oka, S., Satomi, H., Sekino, R., Taguchi, K., Kajiwara, M., Oi, Y., & Kobayashi, R. (2021). Sedation outcomes for remimazolam, a new benzodiazepine. Journal of Oral Science, 63(3), 209-211.https://doi.org/10.2334/josnusd.21-0051
Scherf-Clavel, M., Weber, H., Deckert, J., &Erhardt-Lehmann, A. (2021). The role of pharmacogenetics in the treatment of anxiety disorders and the future potential for targeted therapeutics. Expert Opinion on Drug Metabolism & Toxicology, 17(11), 1249-1260.https://doi.org/10.1080/17425255.2021.1991912
A Sample Answer 3 For the Assignment: NURS 6521 Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
Title: NURS 6521 Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
You made very good points, regarding different anxiolytic drugs for generalized anxiety disorder, such as benzodiazepines and selective serotonin reuptake inhibitors (SSRIs), to treat this disorder. It is true that benzodiazepines work quicker but tolerance develops whereas SSRIs take longer to work but do not have a potential for tolerance. It is interesting though how both of these types of drugs should not be dropped abruptly but must be tapered.
I believe that there are a couple of things that can interfere with treatment and processes for people with this disorder. For one, pain is a big concern. In fact, research shows that people with this disorder tend to share that they have somatic pain frequently (Teh et al., 2009). Some of these reports include chronic back pain as well as arthritis (Teh et al., 2009). Additionally, people with this disorder tend to complain more of a painful condition by about two or three times that of people without this disorder (Teh et al., 2009). Therefore, the drugs may not work as well if patients are dealing with pain issues at the receptor sites.
Additionally, I worked in a residential facility with women who had psychological disorders, such as generalized anxiety disorder, and alcohol and drug addiction. I was an addiction counselor for approximately 15 years prior to going into nursing and discovered that many women self-medicated with alcohol and/or illegal drugs to help cope. This can also interfere with pharmacokinetics and pharmacodynamics because illegal substances alter your thinking and behavior and there becomes competition for receptor sites when trying to use both illegal substances and prescribed drugs, which many of the patients I saw shared that they did.
You mentioned some treatment options, such as cognitive behavioral therapy (CBT). Randomized control trials revealed that participating in activities, such as CBT and yoga were very high compared to other non-drug treatment methods (Szuhany et al., 2022). In fact, 40% preferred yoga whereas 44% preferred CBT (Szuhany et al., 2022). I’m sure that release of neurotransmitters, such as gamma-aminobutyric acid (GABA) and endorphins play a part of this.
Thank you for sharing.
Szuhany, K. L., Adhikari, S., Chen, A., Lubin, R. E., Jennings, E., Rassaby, M., Eakley, R., Brown, M. L., Suzuki, R., Barthel, A. L., Rosenfield, D., Hoeppner, S. S., Khalsa, S. B., Bui, E., Hofmann, S. G., & Simon, N. M. (2022). Impact of preference for yoga or cognitive behavioral therapy in patients with generalized anxiety disorder on treatment outcomes and engagement. Journal of Psychiatric Research, 153, 109–115. https://doi.org/10.1016/j.jpsychires.2022.07.008
Teh, C. F., Morone, N. E., Karp, J. E., Belnap, B. H., Zhu, F., Weiner, D. K., & Rollman, B. L. (2009). Pain interference impacts response to treatment for anxiety disorders. Depression and Anxiety, 26(3), 222–228. https://doi.org/10.1002/da.20514
A Sample Answer 4 For the Assignment: NURS 6521 Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
Title: NURS 6521 Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
According to Piazza, Gesselman & Garcia (2023), depression can occasionally contribute to sexual difficulties that have an impact on sexual functioning that is independent of depressed symptoms. Women have a greater than twofold likelihood of taking SSRI medicine compared to men and so sexual dysfunction also occur in woman, like men.
My course of action to manage side effects of sexual dysfunctions at a follow up visit is in keeping with the following recommendations from Klass, Siva, Bak, Govers & Schrieber (2023).
- Reduce the dosage- The sexual side effects may diminish while using a lesser dosage, while still maintaining its therapeutic effectiveness.
- Arrange a specific time for sexual activity- Consumption of the drug may result in heightened adverse effects during specific periods of the day, such as shortly after ingestion. Thereforecarranging sexual activity at the period when the side effects are least troublesome.
- Engage in a period of drug cessation- discontinue use of thr SSRI for a brief period, such as a few days, specifically before a weekend, if that aligns with your intention to engage in sexual activity.
- Transition to an alternative medication- Antidepressants such as bupropion (Wellbutrin) and mirtazapine (Remeron) have a lower likelihood of causing sexual dysfunction. Bupropion, a medication that has an impact on both norepinephrine and dopamine, may occasionally enhance sexual responsiveness.
- Prescribe a pharmaceutical substance- Sildenafil (Viagra) or tadalafil (Cialis) to relieve SSRI-induced erectile dysfunction in certain men. Both males and females can derive advantages from incorporating bupropion into their therapeutic regimen. This medicine has been discovered to mitigate the sexual dysfunction caused by SSRI medications, enhance sexual desire and arousal, and amplify the intensity or duration of an orgasm. Buspirone (BuSpar), an anti-anxiety medication, may enhance sexual desire and reinstate the capacity to achieve orgasm in certain individuals.
- Refer to psychotherapist- Problems that cause patients to withdraw from intimacy can resolved with the help of a sex therapist or general therapist. These providers can assist couples in examining their sexual difficulties, enhancing their communication skills, and broadening their range of sexual activities.
References
Klass, S., Siva, J., Bak,M., Govers, M.& Schrieber, R. (2023). The Pathophysiology of Post SSRI Sexual Dysfunction-Lessons from a Case Study: Biomedicine and Phramacology. https://doi.org/10.1016/j.biopha.2022.114166Links to an external site..
Piazza, M., Gesselman, A.,& Garcia, J. (2023). SSRI-Associated Sexual Side Effects: How are women impacted? 20: (2). The Journal of Sexual Medicine. https://doi.org/10.1093/jsxmed/qdad061.093.
A Sample Answer 5 For the Assignment: NURS 6521 Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
Title: NURS 6521 Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
The significance of examining the increasing interest in utilizing cannabis as a potential remedy for anxiety cannot be overstated, as emphasized by (Dragioti et al., 2019). Nevertheless, it is imperative to acknowledge the intricate nature and potential hazards linked to the utilization of cannabis in the treatment of anxiety disorders.
Despite the fact that the number of doctors prescribing cannabis for anxiety has significantly increased, it’s critical to stress the need for more thorough research in this field. (Dragioti et al., 2019) highlighted the limited availability of thorough research that compares the effectiveness and safety of cannabis with recognized anxiety medicines. The absence of empirical evidence is a significant challenge for healthcare practitioners in delivering evidence-based advice to patients.
(Dragioti et al., 2019) observation that there is a risk of elevated anxiety levels with increased cannabis use further emphasizes the significance of comprehending the dose-response connection and individual variability in reaction to cannabis. It is imperative to take into account various factors, including the specific strain of cannabis, the tetrahydrocannabinol (THC) concentration, and an individual’s vulnerability to anxiety-related adverse effects.
Given these issues, it is imperative for healthcare providers to exercise prudence when considering the utilization of cannabis as a treatment for anxiety. It is crucial that they furnish patients with impartial and comprehensive information regarding the prospective advantages and drawbacks associated with its use. In addition, patients should be encouraged to investigate further evidence-based therapies that have a better track record of controlling anxiety disorders (Hofmann et al., 2014). Examples of such therapies include psychotherapy and medication.
The use of cannabis for treating anxiety is becoming more popular, but it is still important to base recommendations on reliable scientific research. Further investigation is necessary in order to comprehensively comprehend the potential hazards and advantages of cannabis as a therapeutic intervention for anxiety. Consequently, healthcare practitioners ought to persist in depending on existing treatments that have demonstrated effectiveness until additional empirical evidence is accessible.
References:
Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015, September 4). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics, 12(4), 825–836. https://doi.org/10.1007/s13311-015-0387-1Links to an external site.
Dragioti, E., Solmi, M., Favaro, A., Fusar-Poli, P., Dazzan, P., Thompson, T., Stubbs, B., Firth, J., Fornaro, M., Tsartsalis, D., Carvalho, A. F., Vieta, E., McGuire, P., Young, A. H., Shin, J. I., Correll, C. U., & Evangelou, E. (2019, December 1). Association of Antidepressant Use with Adverse Health Outcomes. JAMA Psychiatry, 76(12), 1241. https://doi.org/10.1001/jamapsychiatry.2019.2859Links to an external site.
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2014, January 8). Erratum to: The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research, 38(3), 368–368. https://doi.org/10.1007/s10608-013-9595-3Links to an external site.