ANSWER
1st discussion replay
One of the most common anxiety disorders is generalized anxiety disorder (GAD), which is characterized by excessive and persistent worrying and anxiety about normal day-to-day circumstances such as job security, children’s well-being, health, and so on (Newman et al.,2017). The presence of the described symptoms is required by the DSM-V manual diagnostic criterion for GAD, with worry being the core criterion for most days for six months. Controlling anxiety is also difficult (Newman et al.,2017). A 56-year-old man presented to the clinic after being referred by his primary care provider for the assignment case study. He’d gone to the ER earlier with symptoms of shortness of breath, chest tightness, and a sense of impending doom. Because the emergency room tests ruled out a myocardial infarction, he was referred to a psychiatric clinic for further evaluation.
During the evaluation, the patient discloses a history of alcohol consumption to help him deal with job-related concerns. The patient also reported drinking 3 to 4 beers in the evening to relax after caring for his aging parents. The patient received a score of 26 on the Hamilton Rating Anxiety Scale (HAM-A), indicating severe anxiety (Thompson, 2015). As a result, the patient’s history and evaluation revealed that he had GAD. This paper aims to discuss how to evaluate and prescribe medication for clients who require anxiolytic therapy, as well as how pharmacokinetics and pharmacodynamics affect drug response.
Steps to Take Based on Patient Factors
The patient was started on 50 mg of Zoloft orally at first. Along with SNRIs, benzodiazepines, 2 ligands, and buspirone, Zoloft, a Selective Serotonin Reuptake Inhibitor (SSRI), is one of the first lines of treatment for GAD. SSRIs have shown to be more effective and faster than serotonin-norepinephrine reuptake inhibitors (SNRIs). While imipramine, a tricyclic antidepressant, is effective as an anxiolytic, it has side effects such as cardiac arrhythmias and extrapyramidal symptoms (Newman et al., 2017). It is also a sedative, so it may exacerbate sedative effects in people who drink alcohol and even promote suicidal ideation. Buspirone has no immediate anxiolytic effects because it takes 2 to 4 weeks to take effect and is typically used to supplement the actions of SSRIs and SNRIs. In four weeks, the client returns to the clinic with fewer symptoms and a HAM-A of 18, down from 26. There have also been no reported side effects.
I decided to increase the dosage of Zoloft to 75 mg for the second decision point because the patient had no side effects from the medication. To monitor response and avoid side effects, the decision was made to increase to 75 rather than 100. The goal was to lower his HAM-A score even further by lowering his anxiety levels. Four weeks later, the client’s anxiety levels had decreased further, with a HAM-A of 10. His symptoms had gone down by 61%. At the prescribed dose, this indicated a good response and tolerance to the medication.
At 75mg of Zoloft, the client demonstrated good tolerance and response. At this point, the decision was made to keep the treatment at the same dose rather than increase it and risk causing side effects that would impair adherence. If the patient had not responded to treatment, buspirone would have been added as an augmentation. We anticipate that we will see further improvement in 12 weeks.
Pharmacotherapeutics
Sertraline is an SSRI, which means it inhibits serotonin uptake at the neuron junction. The neurotransmitter accumulates, facilitating transmission and ensuring appropriate emotions while lowering anxiety levels. Because it has no sedative effects, the medication is well tolerated and appropriate, especially for this individual given his history of alcohol abuse.
Factors Influencing Pharmacokinetics and Pharmacodynamics in Patients
One of the most important factors influencing the patient’s pharmacokinetics and pharmacodynamics is his alcohol consumption history. Given the actions of sertraline at the neuron junction to block serotonin receptors, inhibiting uptake and thus encouraging the accumulation of serotonin, a mood-stabilizing hormone (Newman et al., 2017). Because alcohol temporarily raises serotonin levels, it has the potential to amplify sertraline’s CNS side effects such as dizziness, poor concentration, and drowsiness. It may also increase the likelihood of suicidal thoughts and behaviors. Furthermore, studies show that males, such as the patient, do not respond as well to psychotropics like sertraline as women do, and thus may require higher doses (Newman et al., 2017). Bottom of the Form
Discussion Response 2
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Generalized anxiety disorder (GAD) is characterized by an inability to control one’s worrying (Generalized Anxiety Disorder (GAD), 2021). People with GAD worry about things that are unlikely to happen, and their daily activities can be disrupted as a result of their excessive worrying. GAD is diagnosed by healthcare providers when you worry on most days for at least six months (Generalized Anxiety Disorder (GAD), 2021).
There are several medications available to treat generalized anxiety disorder. One commonly used treatment is selective serotonin reuptake inhibitors (SSRIs). Selective serotonin reuptake inhibitors are antidepressants that can relieve anxiety symptoms while also helping to reduce the symptoms of depression that are frequently associated with anxiety (Treatment Options for Generalized Anxiety Disorder, 2017). It takes 2 to 6 weeks for SSRIs to begin reducing anxiety. SRIs, including both SSRIs and SNRIs, and busPIRone have been approved as first-line treatments by the Food and Drug Administration (FDA). Venlafaxine, DULoxetine, PARoxetine, and escitalopram are the four antidepressants approved for GAD. Benzodiazepines are among the second-line options. SSRIs inhibit serotonin reabsorption in neurons, making more serotonin available to improve neuronal communication (Treatment Options for Generalized Anxiety Disorder, 2017). These medications are considered safe and have few side effects that usually go away after a few weeks and can cause sexual dysfunction or a decrease in sexual interest (Treatment Options for Generalized Anxiety Disorder, 2017). SNRIs help relieve depression by causing changes in brain chemistry and communication in brain nerve cell circuitry known to regulate mood. DULoxetine and venlafaxine are SNRIs that are also considered safe to take, despite the fact that SSRIs have fewer side effects than SNRIs.
Another medication used to treat GAD is benzodiazepines. ALPRAZolam, chlordiazePOXIDE, clorazepate, diazePAM, LORazepam, and oxazepam are all benzodiazepines. Benzodiazepines work by increasing the binding of GABA to its receptors (Elgarf et al., 2018). GABA opens the chloride ion channel, allowing chloride ions to enter the neuron, which hyperpolarizes and inhibits the neuron (Elgarf et al., 2018). Benzodiazepines are effective for the treatment of anxiety disorders and should be used with caution after screening for relevant risk factors for negative outcomes, such as a history of substance abuse, current opioid and alcohol use, fall risk, and cognitive impairment (Tibrewal et al., 2021). Because benzodiazepines can be addictive, they are usually only used in the short term.
Pathophysiology, genetics, diet, environment, body weight, pregnancy, and drug-drug or food-drug interactions all have an impact on pharmacokinetics (Pharmacokinetics | AACC.org, n.d.). Body composition differences between sexes, including changes in total body water, body fat percentage, muscle mass, organ size, blood volume and flow, and metabolism enzymes, will affect pharmacokinetics and, ultimately, the therapeutic effects of the medicine (Pharmacokinetics | AACC.org, n.d.). Drug metabolism may be influenced by genetics, and genetic differences may affect how medications are metabolized in the body. Drug metabolism and elimination are also affected by age. Children may eliminate drugs faster, whereas elderly people with impaired kidney, liver, or heart function may eliminate drugs more slowly. Illness, infection, and inflammation can all slow down drug metabolism, which can increase the drug’s half-life and duration of effect (Pharmacokinetics | AACC.org, n.d.). Interactions between foods, drugs, and herbs, as well as changes in drug metabolism, can all affect the duration and effectiveness of a medicine’s action.
QUESTION
Please respond to both discussions.
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Anxiety Disorder, Generalized