Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
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.Photo Credit: Getty Images/iStockphotoGeneralized 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.To PrepareReview 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.BELOW IS THE QUESTIONPost 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.BELOW IS THE REQUIRED READING—————————please make sure to use APA format 7th edition and please don’t forget to add 5 references not more than 5 years old.Go through the rubric CORE SKILL: comparing agents WITHIN and ACROSS classes for a single indication, and defending the choice for a SPECIFIC patient rather than in the abstract.
THE COMPARISON FRAME the rubric wants: for each agent, address MECHANISM, EFFICACY EVIDENCE, ONSET, SIDE-EFFECT PROFILE, DRUG INTERACTIONS, MONITORING, COST/ACCESS, and SUITABILITY FOR THIS PATIENT (age, comorbidities, pregnancy status, substance history, prior response). An answer that lists three drugs without a patient-specific decision has not done the assignment.
FIRST-LINE — SSRIs: escitalopram and sertraline are the usual first choices for GAD. SERTRALINE has relatively few CYP interactions (useful in polypharmacy) and is generally preferred in pregnancy and lactation. ESCITALOPRAM is clean and well tolerated but is the SSRI most associated with DOSE-DEPENDENT QTc PROLONGATION (as is citalopram, which carries an explicit dose ceiling — 20 mg in patients over 60 or with hepatic impairment). PAROXETINE is highly anticholinergic, most associated with weight gain and sexual dysfunction, has the worst DISCONTINUATION SYNDROME (short half-life), and is a potent 2D6 inhibitor — generally a poor first choice. FLUOXETINE has a very long half-life (so minimal discontinuation syndrome, but a long washout before an MAOI) and is more activating — which may worsen initial anxiety.
SNRIs: VENLAFAXINE XR (dose-dependent BLOOD PRESSURE elevation at higher doses — monitor BP; nasty discontinuation syndrome) and DULOXETINE (useful when there is comorbid neuropathic pain or fibromyalgia; caution in hepatic disease and heavy alcohol use).
THE COUNSELING POINTS THAT DEFINE COMPETENT PRESCRIBING: onset takes 4–6 weeks for full effect; there may be a TRANSIENT INCREASE in anxiety and activation in the first 1–2 weeks (hence start at HALF the usual starting dose in anxious patients); sexual dysfunction affects a large minority and must be asked about directly because patients silently discontinue; do not stop abruptly.
OTHER AGENTS: BUSPIRONE (5HT1A partial agonist — no dependence, no sedation, slow onset, ineffective for panic; good adjunct or option in substance-use history); HYDROXYZINE (short-term, sedating); PREGABALIN; BENZODIAZEPINES (short-term bridging only — dependence, tolerance, falls, cognitive impairment, boxed warning with opioids, and the deeper problem that they can function as a safety behavior that BLOCKS extinction learning in exposure therapy).
SAFETY: serotonin syndrome (hyperreflexia, CLONUS, agitation, hyperthermia, diarrhea — contrast with NMS’s lead-pipe RIGIDITY); hyponatremia/SIADH in the elderly; increased bleeding risk with NSAIDs/anticoagulants (serotonin is required for platelet aggregation — an underrecognized interaction); boxed warning for suicidality under age 25.
DON’T OMIT: CBT is first-line and combination therapy generally outperforms medication alone. And rule out medical mimics (thyroid, arrhythmia, pheochromocytoma) and substance/caffeine contributions before attributing everything to GAD.
Collepals.com Plagiarism Free Papers
Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.
Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.
