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.
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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.
- 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.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
- Chapter 26, “Antipsychotic Agents and Their Use in Schizophrenia” (pp. 203–213)
- Chapter 27, “Antidepressants” (pp. 214–226)
- Chapter 28, “Drugs for Bipolar Disorder” (pp. 228–233)
- Chapter 29, “Sedative-Hypnotic Drugs” (pp. 234–242)
- Chapter 30, “Management of Anxiety Disorders” (pp. 243–247)
- Chapter 31, “Central Nervous System Stimulants and Attention-Deficit/
Hyperactivity Disorder” (pp. 248–254)
Expert Answer and Explanation
Pharmacokinetics and Pharmacodynamics of Anxiolytics
GAD, can be perceived to be a constant feeling of dread or apprehension that is often correlated with a fearful or stressful stimulus. To help prevent this disorder, anxiolytics are prescribed as psychoactive medication. Just like any other medication, anxiolytics undergo the four main stages of Pharmacokinetics entailing absorption, distribution, metabolism, and excretion (Yang et al., 2017). For this case, the main Pharmacokinetics concern is the aspect of distribution which addresses how the drug can reach the brain and provide a relaxing sensation. One of the main anxiolytics used is benzodiazepines as a treatment for GAD. The main components that facilitate the proper distribution of the drug throughout the body are the high affinity with the plasma proteins in the brain. Anxiolytics contain a high affinity to plasma proteins of about 80 to 98 percent (Słupski et al., 2017). The outcome of these binds results in a small free action that can be able to penetrate the blood-brain barrier. In this way, the brain will be able to receive the medication and respond as required.
On the other hand, the pharmacodynamics of anxiolytics act upon the central nervous system. The medication facilitates the inhibition of neurotransmitters in the brain through the production of gamma-aminobutyric acid (GABA) (Chen et al., 2017). However, the effectiveness of the pharmacodynamics of the medication is highly dependent on the mode of pharmacokinetics. As a medical professional, there is a need to understand how different medications can be introduced to the body. Some medication absorption can be inhibited due to being retained in the liver and the mode of introduction can be applied through the use of syringes. Based on the patient preference and the available medication, the mode of treatment can then be decided upon.
Factors Influencing Pharmacokinetic and Pharmacodynamic Processes
There are various factors that can influence the introduction, distribution, and performance of anxiolytics into the human body (Glassman & Muzykantov, 2019). Aspects such as gender genetics, ethnicity, physiological changes, and age have a direct impact on how a person can be administered certain medication. the main characteristic of anxiolytics is that the rate at which they are retained by the liver is high. This makes the best mode of administration to be through the use of syringes. Despite the aspect of age or ethnicity, the medication is best administered through the process (Glassman & Muzykantov, 2019). GAD can represent the core symptoms of anxiety disorder which can prompt the physician to recommend the administration of benzodiazepines and antidepressants. While benzodiazepines present with a relatively similar response in people with diverse characteristics, antidepressants have a diverse variability with regards to drug response.
Different people respond differently to antidepressants despite having the same condition. These responses are attributed to the different gene variants between different people. GAD patients with the long allele of serotonin transporter (5-HTT) gene have a positive response to antidepressants than those without or with alternative transporter genes (McGowan & Reynolds, 2020). To help with appropriate dosage against GAD, the attending medical professional needs to test for the functional CYP450 gene variant that the patient presents. Pharmacogenetics mainly affects the pharmacodynamics of medication in terms of absorption and response of the body to the medication. Other than pharmacogenetics, the physician needs to identify the underlying condition, patient’s ethnicity, and preferences. Autonomy can also affect the type of treatment afforded to the patient (McGowan & Reynolds, 2020). These preferences are mainly associated with the culture, ethnicity, or religion of the patient. The ability to ascribe to a specific treatment or mode of treatment can affect the pharmacokinetic processes of anxiolytics.
Chen, X., Broeyer, F., Kam, M., Baas, J., Cohen, A., & Gerven, J. (2017). Pharmacodynamic response profiles of anxiolytic and sedative drugs. British Journal of Clinical Pharmacology, 83(5), 1028–1038. https://doi.org/10.1111/bcp.13204
Glassman, P. M., & Muzykantov, V. R. (2019). Pharmacokinetic and pharmacodynamic properties of drug delivery systems. Journal of Pharmacology and Experimental Therapeutics, 370(3), 570-580.
McGowan, O. O., & Reynolds, G. P. (2020). Functional pharmacogenetics of serotonin receptors in psychiatric drug action. In Handbook of Behavioral Neuroscience (Vol. 31, pp. 941-957). Elsevier.
Słupski, W., Trocha, M., & Rutkowska, M. (2017). Pharmacodynamic and pharmacokinetic interactions between simvastatin and diazepam in rats. Pharmacological Reports, 69(5), 943-952.
Yang, F., Wang, B., Liu, Z., Xia, X., Wang, W., Yin, D., … & Li, Y. (2017). Prediction of a therapeutic dose for buagafuran, a potent anxiolytic agent by physiologically based pharmacokinetic/pharmacodynamic modeling starting from pharmacokinetics in rats and human. Frontiers in pharmacology, 8, 683.
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