NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
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After the introduction, move into the main part of the NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
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After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
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The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
Anxiety is a type of medical condition whereby the person feels worried, uneasy, nervous, or stressed. According to the American Psychiatric Association, anxiety is defined as an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure. The Diagnostic and Statistical Manual of Mental Health Disorders (DSM-V) classifies anxiety disorders into several main types such as generalized anxiety disorder, panic anxiety, and selective mutism.
Generalized anxiety disorder (GAD) is a type of anxiety that makes a person feel constantly worried. These worrying feelings are about anything and they can last for more than six months. Other symptoms of GAD include nausea, fatigue, trembling, urinating often, sweating hot flashes, irritability, and trouble breathing (Andrews et al., 2010). People diagnosed with GAD are subjected to psychotherapy and medical treatment. The medications used to treat GAD are classified as anxiolytic medications which are a group of drugs used to prevent or treat anxiety symptoms or disorders. They are sometimes called anti-anxiety medications or minor tranquilizers. Anxiolytic medications are habit-forming and can lead to dependency or a substance use disorder. For this reason, they’re often only prescribed for a short amount of time. Some of the anxiolytic medications include SSRIs (sertraline, fluoxetine, paroxetine, and citalopram). Selective serotonin-norepinephrine reuptake inhibitors (SNRI) such as Venlafaxine and Duloxetine have been approved by FDA as a treatment for GAD. Benzodiazepines (alprazolam) and other types of anxiolytic medications such as Second-generation antipsychotics (SGAs).
Before prescribing these drugs to any patient, it is important to understand their pharmacokinetics and pharmacodynamics. For example, the pharmacokinetics and pharmacodynamics of benzodiazepines involve the increase of g-aminobutyric acid (GABA) inhibitory impulses in the central nervous system mediated via benzodiazepine receptors. GABA blocks other activity in your brain, which helps you feel calm and can make you sleepy.
The structure of benzodiazepines is made up of a benzene ring fused to a seven-membered 1,4 diazepine ring. Alprazolam is administered orally and is directly metabolized by hepatic microsomal oxidation (Jahn et al., 2016). They have a peak plasma concentration which occurs after 1 to 2 hours of being taken. Another drug is chlordiazepoxide which although itself has an intermediate half-life (6 — 28 h), its active metabolite desmethyldiazepam has a very long half-life; oral chlordiazepoxide is rapidly and completely absorbed and its volume of distribution varies from 0.25 to 0.50 l/kg. The drug seems to block electroencephalogram arousal from stimulation in the brain stem reticular formation.
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Another type of anxiolytic drug that has been approved to treat GAD is the Selective serotonin reuptake inhibitor (SSRI) drug that works by inhibiting serotonin reuptake transporter and this inhibition of the 5-HT increases the concentration of synaptic hence increasing the extra-synaptic diffusion. An example of SSRIs is fluoxetine which is metabolized through the CYP2D6 system, inhibits CYP2D6 activity, and exhibits considerable intra-individual variability in tolerability and response (Strawn et al., 2018). It also has noradrenergic and dopaminergic effects which putatively underlie its therapeutic efficacy. SNRI is another type of anxiolytic drug used for treating GAD. An example of SNRI such as venlafaxine has been approved by Food Drug Administration to treat GAD. The pharmacokinetics and pharmacodynamics of venlafaxine work through active metabolite, o-desmethylvenlafaxine by inhibiting the serotonin and norepinephrine reuptake transporters albeit with greater potency at the norepinephrine transporter (Gravelle, 2016). Duloxetine has been approved by the FDA to treat GAD. Its pharmacodynamics and pharmacokinetics include the reuptake inhibition of serotonin and norepinephrine at the presynaptic neuron in Onuf’s nucleus of the sacral spinal cord ( ).
Another group of anxiolytic medications used is Non-benzodiazepine Sedative-Hypnotics such as eszopiclone which works by interaction with GABA receptor complexes at binding domains located close to or allosterically coupled to benzodiazepine receptors. Other types of anxiolytic medications are Second-generation antipsychotics (SGAs), Antihistamines, GABA-related interventions, and Tricyclic Antidepressants.
In conclusion, the choice of anxiolytic drug to be prescribed is dependent on the pharmacokinetics and pharmacodynamics factors that might affect the efficacy of the drug. It has been observed that SSRIs and SNRIs are considered the most effective while benzodiazepine and other types of drugs come second. An expert opinion argues that there is a need for healthcare providers to take an optimal pharmacological approach towards integrative pharmacokinetic and pharmacodynamics optimization strategy that would ensure better treatment and personalization of anxiety disorders. According to Almatura et al. (2013), this approach would help in the development of new anxiolytic drugs that are more effective and have limited side, especially benzodiazepines drugs.
References
Altamura, A. C., Moliterno, D., Paletta, S., Maffini, M., Mauri, M. C., &Bareggi, S. (2013). Understanding the pharmacokinetics of anxiolytic drugs. Expert opinion on drug metabolism & toxicology, 9(4), 423-440.
Gravielle, M. C. (2016). Activation-induced regulation of GABAA receptors: is there a link with the molecular basis of benzodiazepine tolerance?. Pharmacological Research, 109, 92-100.
Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert opinion on pharmacotherapy, 19(10), 1057-1070.
Andrews, G., Hobbs, M. J., Borkovec, T. D., Beesdo, K., Craske, M. G., Heimberg, R. G., … & Stanley, M. A. (2010). Generalized worry disorder: a review of DSM‐IV generalized anxiety disorder and options for DSM‐V. Depression and anxiety, 27(2), 134-147.
Jann, Michael W.; Penzak, Scott R.; Cohen, Lawrence J. (2016). Applied Clinical Pharmacokinetics and Pharmacodynamics of Psychopharmacological Agents || Clinical Pharmacokinetics and Pharmacodynamics of Anxiolytics and Sedative/Hypnotics. , 10.1007/978-3-319-27883-4(Chapter 10), 247–266. doi:10.1007/978-3-319-27883-4_10
Sample Answer 2 for NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
This is an in-depth discussion post. Indeed, the treatment of GAD entails both psychotherapy and pharmacotherapy. Essentially, multimodal approaches involving psychotherapy and pharmacotherapy in the management of GAD may distinctively focus on specific symptoms and the inclusion of psychotherapy enhances compliance with treatment and reduces reported adverse effects of pharmacotherapy. Understanding the principles of pharmacokinetics and Pharmacodynamics in the management of GAD is critical in the helping healthcare professionals to make informed decisions about medication formulation and dosage needs (Abuhelwa et al., 2022). It also crucial in building treatment plans entailing medications. The other potential treatment option in this case is psychotherapy. This options involves psychological counseling or talk therapy (Lamb et al., 2019). Here, a patient is expected to work with a therapist to minimize the anxiety symptoms. The popular form of psychotherapy for GAD is cognitive behavioral therapy (CBT). Psychotherapy is CBT aims at teaching particular skills to directly control the patent’s worries and help the patient to slowly return to that had been previously avoided due to anxiety.
References
Abuhelwa, A. Y., Somogyi, A. A., Loo, C. K., Glue, P., Barratt, D. T., & Foster, D. J. (2022). Population pharmacokinetics and pharmacodynamics of the therapeutic and adverse effects of ketamine in patients with treatment‐refractory depression. Clinical Pharmacology & Therapeutics. https://doi.org/10.1002/cpt.2640
Lamb, T., Pachana, N. A., & Dissanayaka, N. (2019). Update of recent literature on remotely delivered psychotherapy interventions for anxiety and depression. Telemedicine and e-Health, 25(8), 671-677. https://doi.org/10.1089/tmj.2018.0079
Sample Answer 3 for NURS 6521 Discussion 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.
Also Read:
NURS 6521: Basic Pharmacotherapeutic Concepts
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.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
Sample Answer 4 for NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
Anxiolytic Medications for Generalized Anxiety Disorder (GAD)
Pharmacokinetics studies how medications are metabolized. Pharmacodynamics studies a drug’s body and brain effects. Anxiolytic medicines are characterized by onset, duration, and anxiolytic effect. Pharmacokinetic variables may affect a patient’s reaction to treatment and how soon drugs work. Someone with liver or renal illness may not be able to metabolize some drugs properly, causing them to build up in the body at greater levels than usual.
Generalized anxiety disorder (GAD) is a mental health condition that causes fear, worry, and a constant feeling of being overwhelmed. It is characterized by excessive, frequent, and unrealistic worry about everyday things, such as job responsibilities, health, or chores. It can affect children and adults.
When treating GAD, consider pharmacokinetics and pharmacodynamics. Individual medication efficacy is the key factor. Some persons have problems metabolizing medications and require dose adjustments. Taking a medicine with a lengthy half-life might create undesirable effects or drug interaction. One of the interventions for GAD treatment is pharmacotherapy. According to Fagan and Baldwin (2023), various medications can be prescribed for a patient suffering from GAD. Choosing from a wide variety of medications would require conversance with the pharmacokinetics and pharmacodynamics in determining effective and safe anxiolytic medications. Therefore, understanding various factors associated with the pharmacotherapy approach in GAD would lead to an effective treatment plan based on observations.
The absorption, distribution, metabolism, and elimination of the anxiolytic drug are associated with their pharmacokinetics. These processes vary among patients with genetics, age, gender, and concurrent health conditions (Li et al., 2019). For example, in a middle-aged male patient suffering from GAD, the metabolism of the anxiolytic medications can be influenced by factors such as genetics and liver function. Distribution of the drugs can also be influenced by body composition, which can potentially alter its effectiveness. Careful monitoring of the patient’s response to treatment should inform adjustments to meet the optimal dose.
Interactions of the anxiolytic drugs with target receptors to produce desired therapeutic effects should inform pharmacotherapy. Different classes of anxiolytic medication for GAD include benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) (Garakani et al., 2020). The working mechanisms differ, and individual variations in receptor sensitivity and function lead to differential responses to treatment. For example, a patient may respond well to SSRIs like sertraline due to their serotonin receptor profile while another one may respond to SNRIs like venlafaxine due to their comorbid depression with GAD and need for dual action on serotonin and norepinephrine systems. Understanding such interactions will inform appropriate personalized treatment plans.
References
Fagan, H. A., & Baldwin, D. S. (2023). Pharmacological treatment of generalized anxiety disorder: Current practice and future directions. Expert Review of Neurotherapeutics, 23(6), 535-548. https://doi.org/10.1080/14737175.2023.2211767Links to an external site.
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, 1-21. https://doi.org/10.3389/fpsyt.2020.595584Links to an external site.
Li, Y., Meng, Q., Yang, M., Liu, D., Hou, X., Tang, L., Wang, X., Lyu, Y., Chen, X., Liu, K., Yu, A., Zuo, Z., & Bi, H. (2019). Current trends in drug metabolism and pharmacokinetics. Acta Pharmaceutica Sinica B, 9(6), 1113-1144. https://doi.org/10.1016/j.apsb.2019.10.001Links to an external site.
Sample Answer 5 for NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
I enjoyed reading your thoughtful post! I relate to your emphasis on knowing pharmacokinetics and pharmacodynamics to choose anxiolytic drugs that are both efficient and safe. A thorough understanding of these processes is necessary to navigate the pharmaceutical selection.
In Generalized Anxiety Disorder (GAD), various factors may impede diagnosed patients’ pharmacokinetics and pharmacodynamics processes. Beyond liver and renal function considerations, drug interactions with medications prescribed for concurrent conditions can alter blood levels and efficacy. Additionally, genetic variations play a role in drug metabolism and inter-individual variability in drug response through polymorphisms in genes encoding drug-metabolizing enzymes or transporters (Johnson-David, 2021).
Non-adherence to prescribed regimens can substantially impact treatment outcomes, potentially resulting in insufficient symptom control or treatment failure (Bautista et al., 2012). Understanding the impact of medication adherence is paramount, influencing both the quality and duration of life, health outcomes, and healthcare costs (Kim, 2018).
Other Lifestyle factors, such as substance use encompassing alcohol and illicit drugs, further complicate the efficacy of treatments, potentially exacerbating anxiety symptoms (SAMHSA, 2023).
In general, for healthcare providers managing GAD, a holistic perspective is indispensable. A personalized approach, adapted to individual patient characteristics and addressing potential interfering factors, fosters more effective and secure treatment outcomes.
Reference:
Bautista, L. E., Vera-Cala, L. M., Colombo, C., & Smith, P. (2012). Symptoms of depression and anxiety and adherence to antihypertensive medication. American Journal of Hypertension, 25(4), 505-511. https://doi.org/10.1038/ajh.2011.256
Johnson-Davis, K.L.(2021). Pharmacokinetics. Retrieved October 17, 2023, from https://www.aacc.org/science-and-research/clinical-chemistry-trainee-council/trainee-council-in-english/pearls-of-laboratory-medicine/2021/pharmacokinetics#Links to an external site.
Kim, J. (2018). Medication adherence: The Elephant in the room. Retrieved October 17, 2023, from https://www.uspharmacist.com/article/medication-adherence-the-elephant-in-the-room#:~:text=Medication%20adherenceLinks to an external site.
Substance Abuse and Mental Health Service Administration (SAMHSA) (2023). Mental health and substance use co-occurring disorder. Retrieved October 17, 2023, from https://www.samhsa.gov/mental-health/mental-health-substance-use-co-occurring-disorders
Sample Answer 6 for NURS 6521 Discussion Comparing and Contrasting Pharmacologic Options for the Treatment of Generalized Anxiety Disorder
The name “generalized” anxiety disorder (GAD) comes from the fear of many things rather than just a few. Generalized anxiety disorder (GAD) is a chronic condition characterized by persistent and long-lasting anxiety that typically starts in early adulthood or adolescence and continues throughout an individual’s life (Rosenthal & Burchum, 2021). Visible behaviors include an intense preoccupation with everyday occurrences and the manifestation of somatic and bodily symptoms like tiredness, muscle tightness, and a rapid heartbeat (Rosenthal & Burchum, 2021).
Pharmacokinetics and pharmacodynamics
Anxiolytics are drugs used for mental health primarily target neurotransmitters in the brain. The drugs facilitate the activation of synapses to enhance mood and alleviate feelings of anxiety (He, Xiang, Gao, Bai & Fan, 20190). Anxiety can be debilitating, but there are several therapies available to treat GAD.
Non-Drug Therapy
Therapy that does not include the use of drugs can be used to treat GAD. Supportive therapy, cognitive behavioral therapy (also known as CBT), biofeedback, and relaxation training are examples of alternatives to pharmacological treatment. These things can be helpful in relieving symptoms and improving coping skills in situations that trigger anxiety. When symptoms are relatively minor, treatment using non-drug methods may be sufficient (Rosenthal & Burchum, 2021).
Cannabis
Dragioti, Solmi, Favaro, Fusar-Poli, Dazzan, & Thompson, (2019) posited that there has been an increase in the frequency with which healthcare providers are recommending cannabis to address anxiety problems. Although there is scarcity of study on the effects of cannabis in comparison to the extensive research conducted on medicine for anxiety. Conversely, it is shared by Dragioti et al, (2019) that heightened consumption of cannabis can result in heightened levels of anxiety.
Benzodiazepines
Rosenthal & Burchum, (2021) stressed that benzodiazipine can temporarily be used in the treatment extreme cases of GAD. The chemical structure of benzodiazepines is highly individualized and has consistent pharmacological properties. Due to their pharmacokinetics and metabolism, they should be used cautiously. These weak acids with high lipophilicity and variable constant dissociation cross membranes quickly (blood-brain and placental barriers, breast milk). Most benzodiazepines are water-insoluble chlordiazepoxide; dipotassium clorazepate, and midazolam, hence organic solutions must be employed for parenteral administration. Short-term anxiety alleviation is usually provided by these sedatives. These medications can be habit-forming, so they should be avoided in patients that misuse alcohol or narcotics. Benzodiazepines can be administered with SSRIs/SNRIs in the weeks before efficacy (Rosenthal & Burchum, 2021).
Tricyclic antidepressants (TCAs)
Antidepressants are commonly prescribed to alleviate anxiety symptoms and are frequently administered in conjunction with treatment for depression as well (Rosenthal & Burchum, 2021). These drugs do not fall within the category of anxiolytics. Antidepressants exhibit efficacy in the management of Generalized Anxiety Disorder (GAD). Imipramine and clomipramine are as effective as second-generation antidepressants that typically cause more side effects than SSRIs or SNRIs (He et al, 2019). Therefore, they should be tried before utilizing TCAs. The dosage should be progressively increased to depression therapeutic levels. TCAs can produce deadly toxicity if overdosed, thus suicidal patients should be cautious. All TCAs are readily absorbed and bind to plasma albumin with 90–95% affinity at therapeutic plasma concentrations after oral dosing. Their ability to attach to extravascular tissues gives them huge distribution volumes (10-50 l kg1). Plasma concentrations between 50 and 300 ng ml1 (molecular weights 263-314), are considered therapeutic (He et al, 2019).
Selective serotonin reuptake inhibitors (SSRIs) and selective serotonin-norepinephrine reuptake inhibitors (SNRIs)
These are first-line drugs due to their favorable benefit-to-risk ratio. Patients should be advised that these antidepressants take 2–4 weeks (sometimes 6 weeks) to reduce anxiety. Adverse effects may worsen in the first two weeks (He et al, 2019). Initial jitteriness or anxiety may reduce treatment compliance. Lowering the antidepressant’s starting dose may reduce negative effects. Many SSRIs and SNRIs are cytochrome P450 enzyme inhibitors, therefore they may interact with other psychopharmacological drugs and medical treatments. After stopping SSRIs, withdrawal symptoms may occur. These are rarer and less severe than benzodiazepine withdrawal symptoms. These adverse effects may be more common with paroxetine than sertraline or fluoxetine (He et al, 2019).
Buspirone
Buspirone is FDA-approved for treating anxiety and is commonly used in conjunction with SSRIs or SNRIs, particularly for GAD. Only azapirone is approved in the US. According to He, et al (2019) buspirone is found to be less effective than benzodiazepines and antidepressants in the treatment of GAD. Buspirone has a strong first-pass effect and is mostly absorbed orally. A 10 mg dose reaches plasma peak in within an hour. Buspirone is excreted through urine and bile (Rosenthal & Burchum, 2021).
Conclusion
According to Sartori & Singewald (2019), both selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, sertraline, citalopram, and escitalopram and serotonin norepinephrine reuptake inhibitors (SNRIs) like venlafaxine and duloxetine, as well as dopamine norepinephrine reuptake inhibitors such as bupropion are successful therapies for generalized anxiety disorder. However selective serotonin reuptake inhibitors (SSRIs) are favored over tricyclic antidepressants for depression and anxiety. Antipsychotic drugs such as Quetiapine (Seroquel) also have characteristics that alleviate feelings of anxiety (Rosenthal & Burchum, 2021).
References
Dragioti, E., Solmi, M., Favaro, A., Fusar-Poli, P., Dazzan, P.,& Thompson, T. (2019). Association of antidepressant use with adverse health outcomes: a systemic umbrella review:JAMA Psychiatry. 76:1241-55. doi:10.1001/jamapsychiarty.2019.2859.
He, H., Xiang, Y., Gao, F., Bai, L., & Fan, Y. (2019. Comparative efficacy and acceptability of fisrst-line drugs for the acute treatment of generalized anxiety diaorder in adults:a network meta-analysis: J Psychiatr Res. 118:21-30. doi:10.2016/j.jpsychires.2019.08.009.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier
Sartori, S.B., & Singewald, N.(2019). Novel Pharmacological targets in drug development for the treatment of anxiset and anxiety-related disorders: Pharmacol Thel 204:107402. doi:10.1016/j.pharmthera.2019.107402.