Laura Rosa

Florida National University

NGR 6172: Advanced Pharmacology

Dr. Latoya Dotson

April 5, 2022

The treatment decisions for generalized anxiety disorder mainly depend on how significantly the disorder has affected the patient’s life. For L. P’s condition, the main treatments to be used will be through combining medication and psychotherapy (Herbert et al, 2019). The main symptoms the patient is being treated for include nervousness, restlessness, fatigue, and the patients’ complaints of having a blank mind. 

For first-line treatment of GAD, I would prescribe Selective Serotonin reuptake Inhibitors (SSRIs); specifically Escitalopram and serotonin norepinephrine reuptake inhibitors specifically Duloxetine. These medications are antidepressants and hence they increase the levels of serotonin in the brain. 

Serotonin is one of the neurotransmitters which carry signals between nerve cells. The SSRIs block the reabsorption of serotonin, which is a neurotransmitter in the brain (Cui et al., 2020). For L.P since she is suffering from depression, the areas of her brain thar regulate mood and send messages using serotonin do not function properly. 

As the clinician I should check in with the patient in about 2 to 4 weeks, whereby positive changes should already be noticeable, although the full effect of the medication will be felt after several months. However, if the patient is still experiencing irritability, insomnia and there is no nerve relaxation after 6 weeks, the medication should be changed. If the medication is effective, the patient should take the medication for another 6 to 12 months and I should gradually reduce the dose. 

If the Escitalopram have severe side effects for example insomnia, and nausea, the patient can be prescribed to Fluoxetine. Fluoxetine inhibits the reabsorption of serotonin which can help in the treatment of Generalized Anxiety Disorder. 

The second-line for therapy would be Buspirone which is used to treat anxiety in the case that SSRIs have adverse side effects for the patient (Kim et al., 2021). It will make the patient think more clearly, calm their nerves and relax, and the patient will be able to take part in everyday life. The medication can also help the patient who has trouble sleeping.

References 

Cui, Q., Sheng, W., Chen, Y., Pang, Y., Lu, F., Tang, Q., … & Chen, H. (2020). Dynamic changes of amplitude of low‐frequency fluctuations in patients with generalized anxiety disorder. Human brain mapping, 41(6), 1667-1676.

Kim, J. K., Han, S. K., Joo, M. K., & Kim, D. H. (2021). Buspirone alleviates anxiety, depression, and colitis; and modulates gut microbiota in mice. Scientific reports, 11(1), 1-12.

Hebert, E. A., & Dugas, M. J. (2019). Behavioral experiments for intolerance of uncertainty: Challenging the unknown in the treatment of generalized anxiety disorder. Cognitive and Behavioral Practice, 26(2), 421-436.

Student: Jean Omega Fleurgin

 Instructor: Dr. Latoya Dotson

1-List specific treatment goals for L.P.

Treatment decisions are based on how significantly generalized anxiety disorder is affecting your ability to function in your daily life. The two main treatments for generalized anxiety disorder are psychotherapy and medications.

 Another long-term aim of treatment is to improve its quality of life and get it back to its core functioning by fully addressing its anxiety symptoms. By pharmacotherapy, the nurse professional aims to reach a full recovery of the disorder

 Talk therapy or psychological counseling, psychotherapy involves working with a therapist to reduce your anxiety symptoms. Cognitive behavioral therapy is the most effective form of psychotherapy for generalized anxiety disorder.

Generally a short-term treatment, cognitive behavioral therapy focuses on teaching you specific skills to directly manage your worries and help you gradually return to the activities you've avoided because of anxiety. 

2-What drug therapy would you prescribe? Why?

Several types of medications are used to treat generalized anxiety disorder. Antidepressants, including medications in the selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) classes, are the first line medication treatments. An anti-anxiety medication called buspirone may be used on an ongoing basis. Benzodiazepines. In limited circumstances, your doctor may prescribe a benzodiazepine for relief of anxiety symptoms. These sedatives are generally used only for relieving acute anxiety on a short-term basis.

3 -What are the parameters for monitoring the success of the therapy?

Monitoring the effectiveness of treatment with the patient is for her to record her symptoms on her own. There are 7 questions in the PROMIS Emotional Distress-Anxiety-Short Form that she can fill out before she meets with the CNP. This evaluation method was created by the American Psychiatric Association to chart success in recovery. The CNP can also check for the adverse effects and adherence to the drug. If the patient experiences adverse effects, it may make her not comply with the medication.

CBT addresses the role of irrational thinking in how patients feel and behave. CBT for GAD typically includes patient self-monitoring of worrying or related symptoms; cognitive restructuring, including evaluating and reconsidering interpretive and predictive thoughts/worries; relaxation training; and rehearsal of coping skills. Patients may be asked to monitor their symptoms of anxiety along with situational factors and thoughts leading up to episodes of increased anxiety. This information is used to help them recognize triggers of anxiety and patterns of maladaptive thinking. Patients are taught to challenge unrealistic or unwarranted worrying and to replace these thoughts with more realistic problem-solving strategies.

4-. Describe specific patient monitoring based on the prescribed therapy.

If the patient is currently complaining that she feels nervous, the provider can recommend Klonopin to cope with her anxious thoughts. As provider would expect to teach patient that Klonopin would not relieve her anxiety in the long term and is mainly for use in the short term. She has to realize that counseling aims to fully alleviate her anxious symptoms. This can be done by standardizing the paroxetine and re-assessing her symptoms relief in 48 weeks. The medical practitioner should recommend L.P to restrict the Klonopin use when she thinks that she is stressed.

5-List one or two adverse reactions for the selected agent that would cause you to change therapy.

The side effect of Paroxetine include insomnia, weight gain, anxiety, symptoms of GI, and sexual impairment. Paroxetine is more prone than the other drug options to have sexual dysfunction and weight gain. The age of the patient and her sexual function and weight and may be of great concern to her. That could eventually cause deterioration of her GAD or failure to comply with her prescription to accumulate an unhealthy weight amount or being unable to reach an orgasm. If she was to undergo sexual dysfunction or weight gain, this might lead the provider to alter patient treatment.

6-What would be the choice for second-line therapy?

Second-line therapies for GAD include pregabalin (Lyrica) and quetiapine (Seroquel), although neither has been evaluated for PD. Pregabalin is more effective than placebo but not as effective as lorazepam (Ativan) for GAD. Weight gain is a common adverse effect of pregabalin. There is limited evidence for the use of antipsychotics to treat anxiety disorders.

Reference:

 Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2017.

 Villelixe Soto

Advanced Pharmacology

           It is important to discuss with L.P. how generalized anxiety typically involves excessive worry about unrealistic threats, various bodily expressions of tension, overarousal, and hypervigilance, and avoidance of what is threatening that interact to maintain the problem. Additionally, it is important to discuss how treatment targets worry, anxiety symptoms, and avoidance to help the client manage worry effectively, reduce overarousal, and eliminate unnecessary avoidance (Dion, 2018). Some studies evaluating anxiety treatments assess non-specific anxiety-related symptoms rather than the set of symptoms that characterize GAD or PD. When possible, the treatments described in this section will differentiate between GAD and PD; otherwise, treatments refer to anxiety-related symptoms in general (Starcevic, 2017).

           Examples of antidepressants used to treat generalized anxiety disorder include escitalopram (Lexapro), duloxetine (Cymbalta), venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva). Monitoring for success of these drugs is monitoring whether the symptoms have lessen or been eliminated. An effective tool to monitor the pharmaceutical is through compliance rates. Factors in common with other medical disorders include intolerance of adverse effects and difficulty in accepting the need for long-term treatment.

           Some of the more common adverse events associated with SSRI and SNRI use include nausea, agitation, weight gain, and insomnia (Starcevic, 2017). Although these effects tend to be mild, they may be mistaken for worsening anxiety and may lead to nonadherence; thus, patients should be advised accordingly. Due to their positive benefit/risk balance, selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SNRIs are recommended as first-line drugs. Patients should be informed that the onset of the anxiolytic effect of these antidepressants has a latency of 2 to 4 weeks (in some cases up to 6 weeks).

References

Dion, S. (2018). Leading treatments for anxiety disorder. Journal of Clinical Psychiatry, 63(9), 756–757.

Starcevic, V. (2017). The treatment of anxiety and related disorders. Expert Review, 14, 18(11), 1275–1286.