Sample Answer for NURS 6521 Week 8: 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.
A Sample Answer For the Assignment: NURS 6521 Week 8: Generalized Anxiety Disorder
Title: NURS 6521 Week 8: Generalized Anxiety Disorder
Pharmacokinetics and Pharmacodynamics Generalized anxiety disorder (GAD) is one of the most common, long-term mental disorders that is associated with feelings of anxiety and illogical concern in a broad range of events rather than one single event (Admin, 2020). Symptoms of GAD include high blood pressure, rapid breathing, difficulty sleeping, sweating, etc. Patients with GAD are constantly stressed and exhausted. Anxiolytic medications, such as buspirone (BuSpar), are used to treat GAD. BuSpar works by inhibiting the release of serotonin, thus decreasing the activation of postsynaptic serotonin receptors (Quock, 2021). This improves the patient’s mood and symptoms of GAD. BuSpar is given orally and is not a sedative. It has no abuse potential. Hepatic and renal impairment causes an increased amount of serum BuSpar in the bloodstream. Whereas age and gender have no significant impact on the pharmacokinetics of BuSpar.
A Sample Answer 2 For the Assignment: NURS 6521 Week 8: Generalized Anxiety Disorder
Title: NURS 6521 Week 8: Generalized Anxiety Disorder
The most prevalent kind of mental illness and a primary contributor to people’s inability to work is generalized anxiety disorder, sometimes known as GAD (Garakani et al., 2020). It is a severe form of persistent anxiety and worries about several aspects of a person’s life, such as their job, school, family, and connections with other people. Symptoms such as extreme weariness, restlessness, difficulty concentrating, forgetfulness, irritability, sleep impairment, tachycardia, and sweating are common indicators of this condition. The majority of the time, a person who suffers from generalized anxiety disorders also has additional mental diseases, such as major depressive disorder, obsessive-compulsive disorder, and anti-social tendencies (Patriquin & Mathew, 2017).
The anxiety disorder known as generalized anxiety disorder (GAD) can be treated in a variety of methods, such as through individual treatment, group therapy, and the management of medication. Non-pharmacological management involves psychotherapy and the development of coping strategies to deal with stressful events that have the potential to bring on anxiety episodes. Some examples of these skills include relaxation breathing exercises and cognitive behavioral therapy (CBT). A number of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been granted approval by the Food and Drug Administration (FDA) for the treatment of generalized anxiety disorder (GAD) (Garakani et al., 2020).
The first-line medication for generalized anxiety disorder (GAD) is called selective serotonin reuptake inhibitors (SSRIs), and it works by preventing the reuptake of serotonin. The hormone serotonin is responsible for maintaining a person’s consistent state of mind. By inhibiting the serotonin uptake receptor, more serotonin will be available in the synaptic cleft. This will allow for greater stimulation of the neurons by increasing the levels of serotonin that are available, which in turn can affect an individual’s mood and assist with the treatment of anxiety disorders. Due to an increased risk of severe side effects, SSRIs are typically not suggested for the following groups of people: women who are pregnant or breastfeeding; children under the age of 18; anyone who have diabetes, epilepsy, or kidney illness (National Health Services, 2021).
As the first antidepressant to receive FDA approval for the treatment of generalized anxiety disorder (GAD), venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI). Patients with or without concomitant disorders like depression are eligible for treatment with this modality. It takes about a week for a patient to begin to feel the effects of this treatment because it is not a quick fix. As a result, it is not a good option to go with in a critical situation. Weaning off of this medicine needs to be done cautiously in order to avoid withdrawal symptoms, just like benzodiazepine does. When taken in high doses, the adverse impact is likely to cause hypertension. It is not recommended to take venlafaxine in conjunction with a monoamine oxidase inhibitor (MAOI). Insomnia, nausea, sweating, and headaches are some of the other potential adverse effects (Rosenthal & Burchum, 2018).
Escitalopram is a type of SSRI that has also been approved for the treatment of GAD. This medication may be prescribed to individuals who have or do not have concomitant illnesses such as depression. Alternative treatment for anxiety that is superior to benzodiazepines in terms of its ability to alleviate both the physical and mental symptoms of the condition. Nausea, perspiration, headaches, and sleeplessness are some of the adverse effects (Rosenthal & Burchum, 2018).
The body’s stomach pH progressively decreases with age, which can limit the pace at which a medicine is absorbed into the body in older adults. Imagine that the drug has been given the green light to be prescribed to those of advanced age. If this is the case, medical professionals need to start prescribing smaller doses first for elderly patients because increasing the dosage too much can raise the danger of overdosing. Because they reduce the likelihood of adverse effects in comparison to other antidepressants, selective serotonin reuptake inhibitors (SSRIs) are the antidepressants of choice for older persons to be prescribed (American Psychological Association, 2019).
Benzodiazepines are an additional favored pharmacological class for the treatment of anxiety disorders. These drugs function by enhancing the response of the body to gamma-aminobutyric acid. It has a rapid onset of action and a large margin of safety while inhibiting neurotransmitters. (Rosenthal & Burchum, 2018). There is a growing propensity towards inappropriate behavior. Patients who have a history of abusing substances such as cocaine, heroin, alcohol, or opioids should have their usage of this medication closely monitored due to the possibility of addiction (Drug Enforcement Agency, n.d). Some patients may suffer sedative effects after beginning treatment with this medication, which manifests itself as a slowing of both mental and physical activity. Patients need to be educated so that they understand that they should continue taking their prescription even if they have these side effects, since they will pass within seven to ten days. Patients who are taking benzodiazepines should also be educated not to suddenly stop taking the drug as this could result in withdrawal symptoms such as delirium, panic episodes, and paranoia. Patients should be educated not to suddenly stop taking the medication. The dosage of the medicine needs to be gradually decreased by the practitioner. Lorazepam and Alprazolam are two examples of different kinds of benzodiazepines. Each has a suggested dosage that the practitioner must administer, taking into account the patient’s adherence to treatment as well as the patient’s health insurance (Rosenthal & Burchum, 2018).
Buspirone
Buspirone is a medication that is used to treat anxiety, and unlike benzodiazepines, it does not have a depressive effect on the central nervous system. Buspirone is a partial agonist for the 5-HT1A receptor and is categorized as an azapirone. It is FDA-approved for the treatment of anxiety and is most frequently used in conjunction with SSRIs or SNRIs, primarily for the treatment of GAD (Garakani, et al., 2020). Buspirone binds to dopamine receptors with a lower affinity than it does to serotonin receptors, which it does with a high affinity. Patients who have a history of abusing drugs or alcohol do not need to be monitored as frequently, and they are not subject to the regulations of the Controlled Substances Act. This makes it a safer option. According to the findings of a Cochrane study on the use of buspirone for generalized anxiety disorder (GAD), the medication was more effective than the placebo but had a smaller effect size in GAD than benzodiazepines and antidepressants (Garakani et al., 2020).
If a patient is transitioning off of benzodiazepines, it is okay for them to begin taking buspirone two to four weeks before beginning the weaning process off of the benzodiazepine. In addition, it does not exhibit the withdrawal symptoms that are associated with benzodiazepines. Buspirone’s absorption can be slowed down by taking it with meals; yet, the drug’s bioavailability can rise as first-pass metabolism is decreased. While using Buspirone, increasing your grapefruit juice consumption or taking antibiotics like erythromycin or ketoconazole can cause your level to rise, which can lead to feelings of tiredness and dysphoria. Other side effects include headaches, nausea, lightheadedness, dizziness, and vomiting (Rosenthal & Burchum, 2018).
References
American Psychological Association. (2019). Depression treatments for older adults. Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts. https://www.apa.org/depression-guideline/older-adults
Drug Enforcement Agency, (n.d.). Drug fact sheet: Benzodiazepines. https://dev9.dea.gov/sites/default/files/2020-06/Benzodiazepenes-2020_1.pdf
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
Munir, S. (2022). Generalized anxiety disorder. https://www.ncbi.nlm.nih.gov/books/NBK441870/
Patriquin, M. A., & Mathew, S. J. (2017). The neurobiological mechanisms of generalized anxiety disorder and chronic stress. Chronic Stress, 1, 247054701770399. https://doi.org/10.1177/2470547017703993
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. Elsevier.