adv pharmacology

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.

Rose angel answer

Pharmacological Options for Treatment of GAD.

The pharmacological management of generalized anxiety disorder involves options which may be the use of anxiolytics and antidepressants (SSRIs and SNRIs). Anxiolytics are mainly of the chemical class of benzodiazepines. The three most common benzodiazepines used in the treatment of GAD are Alprazolam, Clonazepam, and Lorazepam (DeMartini et al., 2019). The pharmacokinetics and pharmacodynamics of these three drugs are almost similar. Alprazolam, Clonazepam, and Lorazepam are rapidly absorbed upon oral administration and reach peak plasma concentration in less than 2 hours. Alprazolam and Clonazepam are 80% and 85% plasma protein bound respectively. Alprazolam and Lorazepam have a half-life of 12 hours whereas clonazepam has a longer half-life of 20-80 hours.

Benzodiazepines are known to cause dependence through the development of tolerance such that a patient will require a higher dose than previously administered to elicit the same effect. Abrupt withdrawal has also been found to cause rebound anxiety. Benzodiazepines’ main mode of action is the enhancement of inhibitory pathway activation through enhanced binding of GABA to its receptors (Huang and Zhao, 2020).

Generalized anxiety disorders can also be managed by the use of antidepressants such as SNRIs and SSRIs. SNRIs such as Venlafaxine increases the levels of norepinephrine and serotonin enhancing the excitatory pathways that alleviate the depression associated with GAD. SSRIs such as Sertraline increase levels of serotonin and in a similar manner to venlafaxine improves the symptoms of GAD (Strawn et al, 2018). The pharmacological management of GAD will depend on other comorbidities that may be present in the patient. A tailored treatment regimen must be reflective of the patient’s special needs if any.

 

 

References

DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized anxiety disorder.  Annals of Internal

            Medicine,  170(7), ITC49-ITC64.

Huang, Y., & Zhao, N. (2020). Generalized anxiety disorder, depressive symptoms and sleep

quality during COVID-19 outbreak in China: a web-based cross-sectional survey.  Psychiatry Research,  288, 112954.

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.

Hazel answer

The pharmacokinetics and pharmacodynamics of anxiolytic medications used to treat GAD can be divided into two main groups: those that act on the central nervous system (CNS) and those that do not. Medications that act on the CNS include benzodiazepines and antidepressants. Medications that do not act on the CNS include buspirone and hydroxyzine. The most common treatment for GAD is pharmacotherapy, which can be divided into two broad categories: anxiolytics and antidepressants. Serotonergic drugs, glutamate modulators, GABAergic pharmaceuticals, neuropeptides, neurosteroids, alpha- and beta-adrenergic agents, cannabinoids, and natural treatments are among the routes and neurotransmitters examined. The analysis found a scarcity of randomized double-blind placebo-controlled trials for anxiety disorders, as well as insufficient research comparing new treatments to existing anxiolytics (Schmidt, et al., 2021). Anxiolytics are medications that relieve anxiety without affecting mood, while antidepressants are medications that treat both anxiety and depression. Most patients with GAD usually have another psychiatric issue (usually depression). The most common class of medication used to treat GAD is the benzodiazepines, which act on the gamma-aminobutyric acid (GABA) neurotransmitter system. Benzodiazepines work by binding to GABA receptors and increasing the neurotransmitter's inhibitory effects. Benzodiazepines are effective in treating GAD and are first choice for acute anxiety. Although used as first-choice, it needs consideration as this can cause dependency. For long term management, buspirone and antidepressants are preferred (Rosenthal & Burchum, 2021). 

 

There are a few other treatment options for GAD that do not involve medication. These include cognitive behavioral therapy, relaxation techniques, and exercise. Relaxation techniques are another non-pharmacological treatment option for GAD. These techniques can help to reduce stress and anxiety by promoting muscle relaxation and calming the mind. When symptoms are mild, nondrug therapy may be an appropriate treatment. Cognitive behavioral therapy has benefits that go beyond just helping to reduce anxiety. It can also help with the symptoms of depression. CBT involves directly confronting your fears, the therapy itself can sometimes be quite distressing and overall, CBT helps patients to be more aware of thoughts and control them better (Informedhealth.org, 2019). If symptoms are uncontrolled with nonpharmacologic techniques, SSRIs, SNRIs, and buspirone are first choice but patient needs to know that initial responses can take weeks to develop. Second line would be benzodiazepines. 

InformedHealth.org. (2019). Treatment options for generalized anxiety disorder. Available from:  https://www.ncbi.nlm.nih.gov/books/NBK279594/

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Schmidt, M. E., Liebowitz, M. R., Stein, M. B., Grunfeld, J., Van Hove, I., Simmons, W. K., & Drevets, W. C. (2021). The effects of inhibition of fatty acid amide hydrolase (FAAH) by JNJ-42165279 in social anxiety disorder: a double-blind, randomized, placebo-controlled proof-of-concept study. Neuropsychopharmacology, 46(5), 1004-1010.

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