Discussion Week 8 _ NURS 6521

Instructions:

Read a selection of your colleagues’ responses and respond to  your colleagues 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.

**minimum of three (3) scholarly references are required for each reply cited within the body of the reply & at the end**

Reply # 1

Beatrice Saina 

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Generalized Anxiety Disorder (GAD)

GAD is a long-term condition marked by overwhelming worry. GAD is the least likely of all anxiety disorders to remit. The majority of GAD patients also have another psychiatric condition, most commonly depression (Rosenthal & Burchum, 2021). GAD is characterized by unreasonable or excessive anxiety over a variety of events or activities, such as school or work accomplishment, that lasts for at least six months. Apprehension, vigilance, stress, poor attention, and problems becoming or maintaining sleep are some of the other psychological aspects. Muscle tension, restlessness, trembling, and symptoms of autonomic hyperactivity, such as tachycardia, palpitations, and sweating, are all somatic manifestations.

Prototype Drugs (Drugs for Anxiety Disorders) ​

· Benzodiazepine - Diazepam

· Nonbenzodiazepine-Nonbarbiturate - Buspirone.

Treatment

GAD can be treated with both non-drug and medication therapies. Cognitive behavioral therapy (CBT), supportive therapy, relaxation training, and biofeedback are examples of non-drug therapies. In anxiety-provoking events, these can help reduce symptoms and enhance coping skills. Nondrug therapy may be sufficient when symptoms are modest (Rosenthal & Burchum, 2021). Drugs, on the other hand, are appropriate if symptoms are really unpleasant or disabling. Benzodiazepines, buspirone, and four antidepressants (venlafaxine, duloxetine, paroxetine, and escitalopram) are among the first-line treatments for GAD now approved by the US Food and Drug Administration (FDA). Other medicines for the treatment of GAD are being used off-label, despite the fact that they are recommended. The benzodiazepines provide immediate relief. The onset of buspirone and antidepressants, on the other hand, is delayed. As a result, benzodiazepines are the medications of choice for quick anxiety relief, particularly when anxiety is intense. Buspirone and antidepressants, on the other hand, are preferable for long-term maintenance. Since GAD is a chronic condition, medication treatment should be continued for at least 12 months, if not longer. Regrettably, drug withdrawal typically leads to relapse, even after extensive treatment. As a result, medication therapy must be continued indefinitely for many patients.

Patient AP is a 46-year-old caucasian male working for a harsh employer, but he can't seem to stop because he has to provide for his ageing grandparents. Antidepressants have some value in treating GAD, however, they are slower acting than benzodiazepines. Imipramine is a tricyclic antidepressant that can help with GAD symptoms, but it should not be used as first therapeutic strategy due to its wide range of negative effects (Bet, et. al., 2013). Reuptake inhibitors just like paroxetine, venlafaxine, and sertraline have a high efficacy in the treatment of GAD (Rosenthal & Burchum, 2021). However, these medications have some negative effects that induce sexual dysfunction, which is distressing for many middle-aged patients and other individuals. These medications, on the other hand, are more suited than benzodiazepines. Benzodiazepines are the first line of treatment for anxiety. The benefits come from improving responses to the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). The benefits start immediately early, and there is a large safety margin. Sedation and psychomotor slowness are the most common adverse effects. The usage of benzodiazepines over an extended period of time can lead to physical dependence. Paranoia, panic, and delirium are all withdrawal symptoms. Patients with GAD may find these particularly distressing.

Personalized Plan of Care

Buspirone is an anxiolytic medication that differs from benzodiazepines in several ways. Buspirone is equally effective as benzodiazepines in the treatments of anxiety and has two significant advantages: it has no addiction potential and does not exacerbate the CNS depressants' effects (benzodiazepines, barbiturates, and alcohol) (Rosenthal & Burchum, 2021). Its main drawback is that anxiolytic effects take a long time to manifest: early reactions take a whole week to manifest, and responses climax after several weeks. Buspirone is not appropriate for PRN usage or for patients who require quick relief due to its delayed therapeutic properties. Buspirone has no potential for abuse, making it a good choice for individuals who have a history of abusing alcohol or other drugs.

Buspirone is an appealing option to benzodiazepines in patients requiring long-term treatment however can't tolerate benzodiazepine-induced sedation and psychomotor slowness due to its lack of depressant characteristics. Buspirone can be an effective therapy for GAD since it decreases symptoms while having fewer sedative qualities and sexual dysfunction adverse effects (Rosenthal & Burchum, 2021). Incorporating antidepressants, benzodiazepine therapy, and psychotherapy is the optimum treatment, since it ensures that the patient improves substantially more than if only one type of treatment is used. This is significant because the patient is working and dwells in a high-pressure environment, making him vulnerable to drug addiction. Because generalized anxiety disorder doesn't really have a single therapy option, it is more effective to use pharmacotherapeutics in GAD.

References

Bet, P. M., Hugtenburg, J. G., Penninx, B. W., van Balkom, A., Nolen, W. A., & Hoogendijk, W. J. (2013). Treatment inadequacy in primary and specialized care patients with depressive and/or anxiety disorders. Psychiatry research, 210(2), 594-600.

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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