COMPARING AND CONTRASTING PHARMACOLOGIC OPTIONS FOR THE TREATMENT OF GENERALIZED ANXIETY DISORDER
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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.
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.
LEARNING RESOURCES
Required Readings
• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
o Chapter 26, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 203–213)
o Chapter 27, “Antidepressants” (pp. 214–226)
o Chapter 28, “Drugs for Bipolar Disorder” (pp. 228–233)
o Chapter 29, “Sedative-Hypnotic Drugs” (pp. 234–242)
o Chapter 30, “Management of Anxiety Disorders” (pp. 243–247)
o Chapter 31, “Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder” (pp. 248–254)
Required Media
• Walden University, LLC. (Producer). (2019a). Adult geriatric depression Links to an external site.[Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat adult geriatric depression.
• Walden University, LLC. (Producer). (2019c). Attention deficit hyperactivity disorder Links to an external site.[Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat attention deficit hyperactivity disorder.
• Walden University, LLC. (Producer). (2019d). Bipolar therapy Links to an external site.[Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics for bipolar therapy.
• Walden University, LLC. (Producer). (2019g). Generalized anxiety disorder Links to an external site.[Interactive media file]. Baltimore, MD: Author.
In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat generalized anxiety disorder.
• Speed Pharmacology. (2018). Pharmacology – Benzodiazepines, Barbiturates, Hypnotics (Made Easy) Links to an external site.[Video]. https://www.youtube.com/watch?v=4ZHudeMho8g&t=24s
Note: This media program is approximately 8 minutes
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.
Write an ESSAY in responds to the essay below.
• 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.
Essay to respond:
In the residential treatment setting in which I work now, we are treating adolescents for multiple mental health disorders, including depression, GAD, and PTSD. Anxiety is the most common psychiatric disorder in adolescents, with approximately 7% of youths in the world experiencing it. Certain types of anxiety are more commonly displayed at certain ages. With the age group of 13-18, social anxiety GAD and panic are more common. Unfortunately, it can be worsened by family issues, traumatic experiences, and other psychiatric disorders (Walter et al., 2020). While generalized anxiety at a low or moderate level can be managed without medication, even preferably, it can become debilitating at a certain level and especially in combination with other diagnoses. Often, clients come in with common signs, including difficulty sleeping, difficulty concentrating in school, apprehension, restlessness and more physical symptoms when anxiety worsens (Rosenthal & Burchum, 2021).
The first options for medication treatment for GAD include SSRIs and buspirone. With this particular age group, SSRIs are the first choice. SSRIs inhibit the reuptake of serotonin in the brain, which increases its availability. Over time, this leads to a downregulation of the inhibitory autoreceptors, heightening serotonergic firing rate. SSRIs are generally well tolerated and improve symptoms (Walter et al., 2020). When combined with cognitive behavioral therapy (CBT), outcomes are optimal (Garcia & O’Neil, 2021). SNRIs are acceptable as well, but side effects can be less easily tolerated and may require more monitoring. SNRIs inhibit the reuptake of both serotonin and norepinephrine. Duloxetine is the only SNRI to have FDA indication for treating anxiety disorders. Of note, there is warning of increased suicidal thoughts through age 24 when starting any of these medications and increasing dose (Walter et al., 2020).
Research shows that factors linked to long term success with medication treatment include male gender, absence of social phobia, successful initial treatment response, higher global functioning, healthy family dynamics, and few negative life events (Garcia & O’Neil). In the residential treatment center, we are able to closely monitor clients and make changes rather quickly if necessary. They are experiencing a lot of change on many levels while in treatment, including psychological, physical and lifestyle, so it’s vital for all parties involved in their care to communicate and adjust as necessary for the best outcomes. For many clients, we have tried various SSRIs, occasionally an SNRI and make dose adjustments often. When medications are started, we get baseline labs and ECGs as needed and monitor progress and side effects. In this setting, we have the luxury of doing this. If these adolescents were outpatient, I would be following up with them weekly to start to monitor effectiveness and make changes as necessary.
References
Garcia, I and O’Neil, J. (2021). Anxiety in Adolescents. The Journal for Nurse Practitioners, 17(1), 49-53. https://doi.org/10.1016/j.nurpra.2020.08.021 Links to an external site..
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Walter, H. J., Bukstein, O. G., Abright, A. R., Keable, H., Ramtekkar, U., Ripperger-Suhler, J., & Rockhill, C. (2020). Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 59(10), 1107–1124. https://doi.org/10.1016/j.jaac.2020.05.005Links to an external site.
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