week 8 peer reply pharmacology
Cheri Fry
Week 8 Initial Post: General Anxiety Disorder
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Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is a mental health condition that is associated with extreme feelings of anxiety, nervousness, and worry that become chronic and intrude upon the person’s ability to enjoy themself or complete daily activities. The topics of worry are usually related to money, health, school, work, and relationships. The concern is disproportionate to the reality of the situation and despite reassurance from family and friends, the feelings continue to be overwhelming. The person often is able to identify that their worry and anxiety is exaggerated but are still unable to redirect their thoughts and control their feelings. The psychological turmoil begins to manifest as physiological symptoms such as headaches, insomnia, chest pain, palpitations, shortness of breath, and gastrointestinal disturbances. Research has demonstrated that this disorder is the result of a dysfunction of one or more brain chemistry and biological processes and is treatable with medication and psychotherapy (The National Institute of Mental Health, 2016).
The case study of a 46-year-old white male who presents with symptoms of GAD with chest discomfort and shortness of breath was evaluated using the Hamilton Anxiety Rating Scale (HAM-A). This tool was first developed in 1959 for the determination of the severity of anxiety symptoms as seen in GAD. This tool has since continued to be used to evaluate and monitor the progress of patients and their response to interventions (Thompson, 2015). His initial HAM-A score of 26 reflects that he is suffering from moderate to severe anxiety (Hamilton, 1959). I decided to begin pharmacological treatment with Buspirone 10mg orally twice a day. My decision to trial the effectiveness of Buspirone first is based on studies that suggest this medication to be equally as effective as an SSRI, such as Zoloft in the treatment of GAD with less side effects (Canadian Agency of Drugs and Technologies in Health, 2012). At the four week follow up appointment with this 46-year-old white male, I found that he had only minimal improvement in his anxiety as determined by his new HAM-A score of 23 and his reports of only a slight decrease in his symptoms. My next decision was to discontinue the use of Buspirone and start Lexapro 10 mg by mouth daily. Lexapro is an SSRI that is a proven effective treatment option for moderate to severe GAD with less side effects than many other SSRIs (Landy & Estevez, 2021). At the four week followup, the 46-year-old white male reports significant improvement in his symptoms and scores a 13 on the HAM-A assessment. With this progress noted, treatment is recommended at the same dosage with only a change in administration time. Taking Lexapro at bedtime is suggested to address a report of drowsiness when taken in the morning. The patient will continue to be monitored and referred for psychotherapy for the continued improvement in his condition and to document his response to treatment. It is hopeful that this gentleman will continue to see improvement in his ability to manage his responsibilities at work and home.
References
Canadian Agency for Drugs and Technologies in Health. (2012). Buspirone for the Treatment of Anxiety: A Review of Clinical Effectiveness, Safety, and Cost-Effectiveness. https://www.cadth.ca/media/pdf/htis/may-2012/RC0349%20buspirone%20Final.pdf
Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50–55. https://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-ANXIETY.pdf
Landy, K., Estevez, R. (2021). Escitalopram. https://www.ncbi.nlm.nih.gov/books/NBK557734/
National Institute of Mental Health. (2016). Generalized Anxiety Disorder: When Worry Gets
Out of Control. https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml
Thompson, E. (2015). Hamilton Rating Scale for Anxiety (HAM-A). Occupational Medicine, 65(7), 601. https://doi.org/10.1093/occmed/kqv05
Second reply
Ernest Isidore
Initial Post: Severe Depression
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Depression is a persistent feeling of unhappiness and loss of interest, which causes someone to decrease in normal daily activities. Montgomery- Asberg Depression Rating Scale (MADRS) is used to diagnose depression. The patient on the case study presented with a score of 51, which indicates severe depression. To conduct the interactive media piece phase, the pharmacological treatment of SSRI Zoloft was chosen to treat severe depression as the drug of choice. There are several therapies available to treat depression. Non-pharmacological therapies commonly used for depression include cognitive-behavioral therapy, interpersonal therapy, and psychodynamic therapy (Mcclintock et al., 2016). My selected case study was about a 70-year-old Hispanic American male with severe depression. The number one decision point I made was to conduct a psychological assessment to collect data about the patient's feelings to get feedback on how he considers his condition.
I decided to order Zoloft 25 mg tablet PO daily because the Montgomery- Asberg Depression Rating Scale (MADRS) revealed that the patient was diagnosed with severe depression. Zoloft needs to be administered once daily in the morning or evening. Zoloft as an antipsychotic contains minimal side effects, such as weight gain as presented by the patient.
I begin with Zoloft 25 mg tablet PO daily. The Client has returned to the clinic in four weeks. He reports a 25% decrease in symptoms. The Client is now concerned about the new onset of erectile dysfunction. Since the side effects of Zoloft caused the recent onset of erectile dysfunction, I decided to decrease the dose to Zoloft by 12.5mg tablet PO daily. The Client one more time has returned to the clinic in four weeks. The patient's erectile dysfunction has subsided. The depressive symptoms have worsened. Finally, a decision was made to change Zoloft to Paxil 20 mg PO daily.
Zoloft can be taken consistently with or without food. This drug causes drowsiness; it needs to be taken at bedtime. The patient was advised to voice any concerns any time he experienced any suicidal thoughts during the first few months of the drug therapy. Many patients experience some improvement in symptoms within one or two weeks of starting Zoloft; the full therapeutic effect generally is achieved in about six to eight weeks of starting the treatment (Mcclintock et al., 2016).
Usually, medications should be used cautiously in patients with impaired hepatic or renal function. With organ damage, it takes longer to excrete the medicines from the body. (Rosenthal & Burchum, 2021). Since the patient did not report any kidney or liver disease, these organs will clear the drug Zoloft from his body well. While administering the pharmacotherapy, it is recommended that the kidney and liver function be monitored closely due to the patient's advanced age (Mcclintock et al., 2016).
The treatment plan that I suggested will help the patient manage his severe depression. A follow-up appointment will be initiated and given to the patient to return for further evaluation.
References
Akgül T, Karakan T, Ayyildiz A, & Germiyanoglu C. (2018). Comparison of sertraline and citalopram for the treatment of premature ejaculation. Urology Journal, 5(1), 41–45.
Mcclintock, A. S., Stiles, W. B., Himawan, L., Anderson, T., Barkham, M., & Hardy, G. E. (2016). An investigation of client mood in the initial and final sessions of cognitive-behavioral therapy and psychodynamic-interpersonal therapy. Psychotherapy Research, 26(3), 377–385. https://doi-org.ezp.waldenulibrary.org/10.1080/10503307.2015.1034796
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
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