Anxiolytic Therapy and PTSD Treatment
Generalized anxiety disorder is an emergent public health concern owing to the effects that it has on the mental health status of an individual suffering from the condition. The condition can be realized by an individual of any age, thus, affecting both the young and those considered as being older (Canu et al., 2015). Often, those suffering from the condition tend to have excessive and persistent worry on issues, some of which they are not capable of controlling. Some of the issues that would often affect such people include relationships, homes being affected by natural disasters, financial pressures and stress at workplaces. Post-Traumatic Stress Disorder is known to be a mental illness that comprises of exposure to trauma due to death or threat of death, sexual violence and any serious injury (Hallion, Steinman & Kusmierski, 2018). The disorder leads to more problems in an individual’s ability to function in both the social and work place as well as affecting one’s relationships in negative ways. Individuals who suffer from the disorder may get treatment. The treatment that is offered to people suffering from PTSD includes psychotherapy as well as medication. Such forms of treatment assist the patients to regain some sense of control over their lives. There are several problems that have been identified in the diagnosis of the condition. However, such problems have
been solved through activates that involve adoption of screenings. Based on the adoption of screening interventions, healthcare practitioners tend to achieve strategic ways of dealing with the condition as well as focusing on the effectiveness of the drugs that are used. In a case where the drugs do not work well, healthcare provider is allowed to change the form of medication in order for the symptoms to be fought effectively. The present paper discusses the case of a white male regarded to be of middle-age whose suffers from PTSD by analyzing the pharmacotherapy options available to the nurse. Moreover, the pharmacodynamics, pharmacokinetics and ethical influences on the elected therapy will be discussed as well.
Decision Point One
Selected Decision
Begin Zoloft 50 mg orally daily
Justification for the Selection
Zoloft is a medication that has been proven as being ideal in the treatment of anxiety disorders in a patient by studies. There is often higher tolerance and effectiveness displayed by this drug during the treatment process.
Additionally, it inhibits the uptake of norepinephrine, neural serotonin and dopamine, which are some of the major causes of anxiety in a patient. The medication has been proven as playing a key role in the elimination of panic attacks that a patient is likely to encounter. The choice of 50mg Zoloft is premised on the understanding that it belongs to the serotonin reuptake inhibitors groups, thus, an ideal medication to use during the commencement of medication for the patient. The patient’s score when the Hamilton Anxiety Rating Scale (HAM-A) is run is 26 (Gale et al., 2019). Such affirms that the he suffered from the generalized anxiety disorders, thus, the need to kick off the treatment with the Issuance of 50mg Zoloft on a daily basis and monitoring of the patient for the first two weeks under which he or she is under medication.
Based on the possible medications that need to be granted to the patient, Imipramine and Buspirone cannot be issued since they are not the first line of medication and can only be issued where there is a failure in the first medication to bring about the desired clinical results for the patient. Moreover, the safety and tolerability profiles of these two medications are not positive compared to Zoloft, which disqualifies them from usage in the present scenario. For these reasons, adopting the usage of Zoloft in the first therapy is the correct decision.
Expected Results
Studies have revealed that the desirable results of the Zoloft medication are often noticeable within one week of being given to the patient. However, for the aged patients, especially those with low plasma count, the results can be evidently existent within two to three weeks of treatment. By the end of the second week, from the date when he commences treatment, there are a set of symptoms that should have been eliminated. First is the shortness in breath that he experiences and second is the reduction in the incidences of chest tightness that the patient experiences. The next checkup after the date when he is examined for the condition needs to be at the end of fourth week. The key expectation during such period is full recovery from the generalized anxiety disorders. The patient needs not to be pressured by the feeling of doom over what he does or from the interactions that he has with other people.
Differences between Expected and Actual Results
The actual results of the HAM-A scale scores during the examination at the 4th week review is in tandem with the expected results by the nurse. Therefore, Zoloft, the medication that had been issued to the patient during the first visit proves to be effective. Some of the evident symptoms from the patient that indicate that he is recovering from the medication include resolution of the tightness of chest and no incidence of shortness of breath as at the fourth week. Additionally, the patient asserts that he is no longer excessively worried about his job and experiences tranquility with his inner self (Niedhammer, Malard & Chastang, 2015). This expectations were met as evidenced by the HAM-A score of 18 during the review.
Decision Point Two
Decision
Increase dose to 75 mg orally daily
Reasons for the Selection
Considering the resolution of some of the symptoms of the condition the selection of Zoloft was justified as the drug has been effective in reducing symptoms of PTSD. Additionally, use of Zoloft 50 mg has not shown any negative impact on the patient since the first dose was administered. This implies that the patient tolerates the drug well. Therefore, raising the dosage will ensure that the plasma concentration of the drug is high, thus, leading to its positive impact. This is opposite to maintaining the dosage at 50 mg, which means that further resolution of the symptoms will not occur. Also, raising the oral dosage to 100 mg puts the patient at risk of being negatively affected by the drug. Therefore, both maintaining of the dosage at 50mg and raising it at 100mg are not effective decisions.
Difference between Expected Results and Actual Results
Through increasing the amount of plasma concentration of the drug, the nurse practitioner estimated that this would lead to a concomitant reduction in the symptomatology of the generalized anxiety disorder. This is true from the report that is given by the patient as it shows that the symptoms have reduced. The reduction is recorded to be 61% according to the proof by HAM A score. Therefore, through increasing the dosage, there is a partial reduction of the symptoms; however, the rate at which the symptoms reduce does not match the expectations of the healthcare provider.