NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS

Sample Answer for NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS 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 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS

Title: NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS

Anxiety is a type of medical condition whereby the person feels worried, uneasy, nervous, or stressed. According to the American Psychiatric Association, anxiety is defined as an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure. The Diagnostic and Statistical Manual of Mental Health Disorders (DSM-V) classifies anxiety disorders into several main types such as generalized anxiety disorder, panic anxiety, and selective mutism.

Generalized anxiety disorder (GAD) is a type of anxiety that makes a person feel constantly worried. These worrying feelings are about anything and they can last for more than six months. Other symptoms of GAD include nausea, fatigue, trembling, urinating often, sweating hot flashes, irritability, and trouble breathing (Andrews et al., 2010). People diagnosed with GAD are subjected to psychotherapy and medical treatment. The medications used to treat GAD are classified as anxiolytic medications which are a group of drugs used to prevent or treat anxiety symptoms or disorders. They are sometimes called anti-anxiety medications or minor tranquilizers. Anxiolytic medications are habit-forming and can lead to dependency or a substance use disorder. For this reason, they’re often only prescribed for a short amount of time. Some of the anxiolytic medications include SSRIs (sertraline, fluoxetine, paroxetine, and citalopram). Selective serotonin-norepinephrine reuptake inhibitors (SNRI) such as Venlafaxine and Duloxetine have been approved by FDA as a treatment for GAD. Benzodiazepines (alprazolam) and other types of anxiolytic medications such as Second-generation antipsychotics (SGAs).

Before prescribing these drugs to any patient, it is important to understand their pharmacokinetics and pharmacodynamics. For example, the pharmacokinetics and pharmacodynamics of benzodiazepines involve the increase of g-aminobutyric acid (GABA) inhibitory impulses in the central nervous system mediated via benzodiazepine receptors. GABA blocks other activity in your brain, which helps you feel calm and can make you sleepy.

The structure of benzodiazepines is made up of a benzene ring fused to a seven-membered 1,4 diazepine ring. Alprazolam is administered orally and is directly metabolized by hepatic microsomal oxidation (Jahn et al., 2016). They have a peak plasma concentration which occurs after 1 to 2 hours of being taken. Another drug is chlordiazepoxide which although itself has an intermediate half-life (6 — 28 h), its active metabolite desmethyldiazepam has a very long half-life; oral chlordiazepoxide is rapidly and completely absorbed and its volume of distribution varies from 0.25 to 0.50 l/kg. The drug seems to block electroencephalogram arousal from stimulation in the brain stem reticular formation.

Another type of anxiolytic drug that has been approved to treat GAD is the Selective serotonin reuptake inhibitor (SSRI) drug that works by inhibiting serotonin reuptake transporter and this inhibition of the 5-HT increases the concentration of synaptic hence increasing the extra-synaptic diffusion. An example of SSRIs is fluoxetine which is metabolized through the CYP2D6 system, inhibits CYP2D6 activity, and exhibits considerable intra-individual variability in tolerability and response (Strawn et al., 2018). It also has noradrenergic and dopaminergic effects which putatively underlie its therapeutic efficacy. SNRI is another type of anxiolytic drug used for treating GAD. An example of SNRI such as venlafaxine has been approved by Food Drug Administration to treat GAD. The pharmacokinetics and pharmacodynamics of venlafaxine work through active metabolite, o-desmethylvenlafaxine by inhibiting the serotonin and norepinephrine reuptake transporters albeit with greater potency at the norepinephrine transporter (Gravelle, 2016). Duloxetine has been approved by the FDA to treat GAD. Its pharmacodynamics and pharmacokinetics include the reuptake inhibition of serotonin and norepinephrine at the presynaptic neuron in Onuf’s nucleus of the sacral spinal cord ( ).

Another group of anxiolytic medications used is Non-benzodiazepine Sedative-Hypnotics such as eszopiclone which works by interaction with GABA receptor complexes at binding domains located close to or allosterically coupled to benzodiazepine receptors. Other types of anxiolytic medications are Second-generation antipsychotics (SGAs), Antihistamines, GABA-related interventions, and Tricyclic Antidepressants.

In conclusion, the choice of anxiolytic drug to be prescribed is dependent on the pharmacokinetics and pharmacodynamics factors that might affect the efficacy of the drug. It has been observed that SSRIs and SNRIs are considered the most effective while benzodiazepine and other types of drugs come second. An expert opinion argues that there is a need for healthcare providers to take an optimal pharmacological approach towards integrative pharmacokinetic and pharmacodynamics optimization strategy that would ensure better treatment and personalization of anxiety disorders. According to Almatura et al. (2013), this approach would help in the development of new anxiolytic drugs that are more effective and have limited side, especially benzodiazepines drugs.

NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS
NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS
  • 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.

 

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A Sample Answer 2 For the Assignment: NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS

Title: NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS

Generalized anxiety disorder affects millions of people worldwide.  There are numerous options for pharmacologic management of this prevalent and debilitating disorder.  This post will provide a case study and considerations for pharmacologic management of the study subject.

“SC is a 39-year-old female who is experiencing chest pain, back pain, heart palpitations and reports shortness of breath stating, “It feels like the air is thick.”  She also reports trouble sleeping due to “over thinking things” but she does not consider this to be worrying.   These symptoms occur approximately four times each week and are most prevalent in the morning when SC is on her way to work.  Current medications include metformin ER 500mg daily, zolpidem 6.25mg daily at bedtime, estradiol transdermal patch 0.075mg twice weekly.  SC reports she has experience episodes of depression and anxiety since age 17 but has not ever seen a doctor for these problems.  Her health history includes polycystic ovary syndrome, total hysterectomy, sleep disorder, and Type II diabetes.  Her BMI is 32.9 which indicates obesity.  She is the single mother of a child who has a diagnosis of autism, and she is building a new home.  Social support includes friends at work and her mother who lives in her home.

A 12-lead ECG shows normal sinus rhythm with no ectopy noted.  SC is diagnosed with generalized anxiety disorder.  Bupropion XL 300mg daily and buspirone 5mg daily are prescribed.  Bupropion XL is an atypical antidepressant that is a weak reuptake inhibitor of norepinephrine and dopamine.  The drug is extensively metabolized with CYP2B6 as the principal isoenzyme involved in metabolism and is excreted in urine and feces.   Bupropion XL peaks in plasma seven hours after dosing.  The half-life of the drug is 21 to 30 hours with steady-state plasma concentrations achieved in eight days (Food and Drug Administration [FDA], 2009).   Drug-drug interactions are common when Bupropion XL is administered with other medications that are metabolized by CYP2D6 isoenzyme.

Buspirone HCL is an antianxiety drug that is not a benzodiazepine.  It does not cause sedation or muscle relaxation which are common side effects of benzodiazepine drugs.  Buspirone has a high affinity for serotonin receptors and dopamine receptors in the brain.  It does not affect GABA binding (Speed Pharmacology, 2018).

Buspirone is rapidly absorbed following oral administration and undergoes extensive first-pass metabolism.  Peak plasma levels of the drug occur in 40 to 90 minutes (Food and Drug Administration [FDA], 2010).  Buspirone is shown to be mediated by CYP3A4 isoenzyme and is safe when taken with bupropion XL.

SC returned was advised to report worsening symptoms of depression or anxiety to the physician and was scheduled for follow up in two weeks.  On return she reported feeling much better with no chest pain, heart palpitations, or shortness of breath for the last five days.  She also reports she is not over thinking things as much as she was prior to treatment.  No changes were made to her medication regimen and additional follow up was scheduled in four weeks.

When deciding how to treat generalized anxiety disorder (GAD) healthcare providers must be careful not to confuse situational anxiety with GAD.  Benzodiazepines are recommended for acute anxiety and panic attacks.  These drugs carry a risk of physical dependence.  Long-term use can cause withdrawal symptoms to occur, and these medications must be tapered over a period of weeks to months (Rosenthal & Burchum, 2021, p. 244).  Other drugs used for the treatment of GAD include Serotonergic reuptake inhibitors (SRIs), tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors, and monoamine oxidase inhibitors (MAOIs).  Of these, all have side effects however MAOIs have a high incident of drug-drug reactions and risk of hypertensive crisis and stroke if the patient eats foods high in tyramine (cheese, cured meats, sauces and alcohol) (Speed Pharmacology, 2018).

GAD is a common psychiatric illness that one in every four people will experience in their lifetime.  Determining the best pharmacologic treatment and combining it with psychotherapy is needed to provide optimal patient outcomes.

References

Food and Drug Administration. (2009). Wellbutrin XL. fda access data. Retrieved April 22, 2022, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021515s023s024lbl.pdf

Food and Drug Administration. (2010). buspirone HCL, USP. FDA access data. Retrieved April 22, 2022, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/018731s051lbl.pdf

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.

Speed Pharmacology. (2018). Pharmacology – Benzodiazepines, barbiturates, hypnotics (Made Easy) [Video]. You Tube. https://www.youtube.com/watch?v=4ZHudeMho8g&t=24s

A Sample Answer 3 For the Assignment: NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS

Title: NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS

Hi Tracey! I enjoyed reading your post! You are correct with your statement that healthcare providers should not be confuse with situational anxiety versus GAD in 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. She was treated in the hospital and after 3 days she went back to the facility. She was prescribed LORazepam Tablet 0.5 MG  to Give 1 tablet by mouth two times a day for anxiety for 6 Months. After 6 months her behavior was reviewed and it shows that it was effective for her and she was maintained on Lorazepam until now. Lorazepam belongs to a class of drugs- Benzodiazepines, which act to the brain and nerves to give a calming effect that ease the symptoms of anxiety. Lorazepam works by enhancing the effects of a certain natural chemical in the body (GABA).It is not a narcotic but may produce narcotic effects (Cunha, 2021).

References

Cherry, Kendra, 2020. What is Situational Anxiety? https://www.verywellmind.com/what-is-situational-anxiety-

Cunha, John P.,2021 Lorazepam. https://www.rxlist.com/consumer_lorazepam_ativan/drugs-condition.htm

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A Sample Answer 4 For the Assignment: NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS

Title: NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS

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.

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 Psychiatry11, 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 Therapy38(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 Pharmacotherapy19(10), 1057–1070. https://doi.org/10.1080/14656566.2018.1491966

A Sample Answer 5 For the Assignment: NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS

Title: NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS

This is an outstanding and impeccable post about pharmacologic options for the treatment of generalized anxiety disorder. Apart from following the treatment plans you have noted in your post, it is imperative to dedicate sufficient time to providing psychoeducation to patients and their families to enhance treatment compliance. Psychoeducation is crucial in empowering patients through the provision of information about the condition treated, dealing with stigma, and recognizing barriers that compromise medication compliance (Newby et al., 2018). It is also important to engage the family of the patient in the treatment plan because they act as the primary support network. They can provide more historical background and help in the development of a treatment plan. Since general anxiety disorder patients tend to be attentive to indications of danger and can misinterpret information, family members can offer more insights into the patient’s problems. Family members can also play crucial roles in helping patients to formulate problem-solving skills and also reduce social isolation through the provision of structured activities to enhance socialization with others and reduce thoughts about problems (Menear et al., 2020).

 

References:

Menear, M., Dugas, M., Careau, E., Chouinard, M. C., Dogba, M. J., Gagnon, M. P., & Légaré, F. (2020). Strategies for engaging patients and families in collaborative care programs for depression and anxiety disorders: A systematic review. Journal of affective disorders263, 528-539. https://doi.org/10.1016/j.jad.2019.11.008

Newby, J. M., Smith, J., Uppal, S., Mason, E., Mahoney, A. E., & Andrews, G. (2018). Internet-based cognitive-behavioral therapy versus psychoeducation control for illness anxiety disorder and somatic symptom disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology86(1), 89. https://doi.org/10.1037/ccp0000248

A Sample Answer 5 For the Assignment: NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS

Title: NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder PEER POSTS

Your post addresses the significance of knowing pharmacokinetics and pharmacodynamics while treating GAD and the numerous anxiolytic drugs accessible. You also emphasize how individual differences in receptor sensitivity and function may result in disparate responses to therapy.

Additionally, it is crucial to remember, for instance, that the kind of drug provided might significantly impact the adverse effects of anxiolytics. For example, SSRIs may induce nausea, sleeplessness, and sexual dysfunction, while benzodiazepines might make you tired, confused, and have memory issues. When prescribing anxiolytic drugs, it’s also important to consider drug interactions since specific prescriptions might interact with one another and have negative consequences that can be very significant (Guina & Merrill, 2018).

Finally, it is essential to remember that psychotherapy is often advised in addition to medication for GAD. Because it enables patients to recognize and change their harmful ideas and actions, Cognitive Behavioral Therapy (CBT) is a particularly successful psychotherapy for GAD. Additionally, GAD may benefit from lifestyle modifications, including consistent exercise, relaxation, and better sleep hygiene (Borza, 2017a).

Overall, your essay does an excellent job of highlighting how crucial it is to comprehend pharmacokinetics and pharmacodynamics while treating GAD. The possibility of medication interactions, the usage of psychotherapy, and dietary changes are just a few of the many additional considerations to consider. Healthcare professionals may design their patients’ most successful treatment plans by considering all these criteria.

References

Borza, L. (2017a). Cognitive-behavioral therapy for generalized anxiety. Dialogues in Clinical Neuroscience19(2), 203–208. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573564/

Guina, J., & Merrill, B. (2018). Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives. Journal of Clinical Medicine7(2), 17. https://doi.org/10.3390/jcm7020017

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